Contrasting Trajectories of Change in Primary Care Clinics: Lessons From New Orleans Safety Net

Article Figures & Data

Table 1

Patient-Centered Medical Home Indices

Index	Domains
Enhanced access (8 domains)	Open hours beyond 8 am to 5 pm on weekdays Open hours during the weekend Telephone advice on clinical issues during office hours Urgent phone responses, after hours or weekends Practice routinely collects access-to-care data Translation services Clinicians communicate with patients via e-mail Interactive Web site for the practice
Quality and safety (10 domains)	Participation in any quality improvement collaboratives Rapid-cycle quality improvement strategy Provide performance feedback to clinicians Alerts for abnormal test results Patient educators for chronic illness and prevention Patient reminders for chronic illness care Patient experience data given to clinicians Use of guideline-based reminders for clinicians Tobacco cessation program Use of organized systems for improving rates of breast cancer screening
Care coordination and integration (9 domains)	Use of electronic health record Able to retrieve laboratory and imaging reports electronically Shared electronic health record with hospital Electronic access to clinical information from hospitals, emergency departments, and specialists Alerts when patients are hospitalized Use of order-tracking system Electronic prescribing Use of chronic disease registries Use of care managers for chronic disease

Table 2

Baseline Organizational Characteristics of 5 Clinics in New Orleans

Characteristic	Clinic A	Clinic B	Clinic C	Clinic D	Clinic E
NCQA PCMH recognition	Yes	Yes	Yes	Yes	Yes
Affiliation	Independent	Faith-based health care system	University medical school	Independent	University medical school
Ownership	Private, nonprofit	Private, nonprofit	Public	Private, nonprofit	Private, nonprofit
Federally Qualified Health Center	No	Yes (May 2004)	No	Yes (March 2009)	No
Full-time equivalent physicians/nurse practitioners, No.^a	1.5	2.8	3.6	3.1	6.5
Unduplicated patients, No.^a	1,489	1,739	4,345	5,455	2,475
Adult and pediatric care	Both	Both	Both	Both	Both
Patients with limited English proficiency, %^b	10	20	4	8	15
Uninsured patients, %^a	83.7	71.6	70.5	71.1	78.1
Patients by race/ethnicity, %^a
African American	54.3	67.1	82.1	72.2	63.5
White	12.4	31.4	14.6	14.9	17.8
Asian	1.3	0.3	0.9	1.2	0.6
Other/unknown	32.0	1.3	2.4	11.7	18.1

NCQA = National Committee for Quality Assurance; PCMH = patient-centered medical home.
↵a Assessed between March 2008 and September 2008.
↵b Assessed in June 2008.