Becoming a Patient-Centered Medical Home: A 9-Year Transition for a Network of Federally Qualified Health Centers

Article Figures & Data

Table 1

Annual Use of PCMH Services by Patients With Diabetes

		Outreach Services^a		Diabetes Education Services^b		Psychosocial Care Services^c		Primary Care Services^d

Group and Year	Patients, No.	Received, %	Mean (SD), No.^e	Received, %	Mean (SD), No.^e	Received, %	Mean (SD), No.^e	Received, %	Mean (SD), No.^e
HbA_1c ≤9%^f
2003	398	59.0	2.1 (3.2)	0.0	0.0 (0.0)	9.0	0.2 (1.1)	99.7	5.4 (3.2)
2004	696	74.4	3.2 (4.4)	0.0	0.0 (0.0)	20.7	0.9 (3.0)	99.7	5.8 (3.8)
2005	914	78.2	3.2 (3.9)	0.0	0.0 (0.0)	26.6	1.0 (4.0)	99.8	5.8 (3.6)
2006	1,031	81.5	3.2 (3.9)	0.0	0.0 (0.0)	25.5	0.9 (2.6)	99.3	5.9 (3.7)
2007	1,085	70.8	3.0 (3.3)	0.0	0.0 (0.0)	17.5	0.7 (2.6)	98.8	5.1 (3.4)
2008	1,251	86.4	3.4 (3.3)	4.1	0.1 (0.4)	18.9	0.7 (2.4)	98.4	5.5 (3.8)
2009	1,512	82.6	3.4 (3.6)	21.1	0.5 (1.4)	19.4	0.7 (2.9)	98.1	4.8 (3.6)
2010	1,731	90.1	4.2 (4.1)	19.4	0.5 (1.2)	19.2	0.9 (3.3)	98.3	4.5 (3.3)
2011	2,057	95.3	5.9 (5.6)	53.3	1.3 (2.2)	27.4	1.0 (3.4)	99.4	4.7 (3.2)
HbA_1c >9%^f
2003	161	60.2	1.8 (2.7)	0.0	0.0 (0.0)	11.2	0.4 (2.4)	99.4	5.9 (4.1)
2004	234	73.9	2.4 (3.2)	0.0	0.0 (0.0)	18.4	0.7 (3.0)	100.0	5.7 (3.9)
2005	307	78.2	2.6 (3.0)	0.0	0.0 (0.0)	25.1	0.9 (4.0)	99.7	5.5 (4.1)
2006	321	72.3	2.5 (2.8)	0.0	0.0 (0.0)	25.2	0.5 (1.8)	99.1	5.3 (3.4)
2007	295	87.8	3.2 (3.3)	0.0	0.0 (0.0)	17.6	0.6 (2.4)	97.6	4.8 (3.6)
2008	369	93.8	4.0 (3.4)	6.2	0.1 (0.4)	22.5	0.7 (2.6)	96.7	5.0 (3.8)
2009	425	96.0	6.3 (5.2)	40.2	0.9 (1.8)	24.9	0.8 (2.8)	97.2	4.6 (3.8)
2010	447	95.3	6.1 (4.6)	39.6	1.0 (1.7)	22.6	1.0 (3.6)	98.2	4.1 (3.2)
2011	551	98.5	8.7 (7.3)	77.8	2.6 (3.3)	35.3	1.2 (3.9)	99.5	4.3 (3.2)

HbA_1c=glycated hemoglobin; PCMH=patient-centered medical home.
↵a Outreach includes (1) telephone and (2) letter.
↵b Diabetes education includes visits with a certified diabetes educator.
↵c Psychosocial care includes office visits or encounters with (1) psychiatry, (2) psychology, and/or (3) social worker.
↵d Primary care includes all office visits not included in diabetes care and psychosocial care.
↵e Mean and SD per patient based on patients with at least 1 visit.
↵f First HbA_1c documented in the calendar year was used to categorize patients into HbA_1c groups.