Article Figures & Data
Figures
- Figure 1
PCMH implementation by practice size, December 2009.
PCMH = patient-centered medical home.
- Figure 2
Patient-centered medical home implementation by domain, December 2009.
Tables
No. Domain Descriptiona Capabilities, No. 1 Patient-Provider Partnership Practice has developed and is using PCMH-related communication tools 8 2 Patient Registry An all-payer registry is used to manage established patients in the practice 18 3 Performance Reporting Performance reports are generated that allow tracking and comparison of results for the established population of patients in the practice 13 4 Individual Care Management Practice has ability to deliver coordinated care management services with an integrated team of multidisciplinary clinicians and a systematic approach is in place to deliver comprehensive care that addresses patients’ full range of health care needs 15 5 Extended Access Patients have 24-hour access to a clinical decision maker by telephone, and the clinical decision maker has a feedback loop within 24 hours or the next business day to the patient’s PCMH 9 6 Test Results Tracking & Follow-up Practice has test-tracking process documented and in place that requires tracking and follow-up for all tests and results, with identified time frames for notifying patients of results 9 7 E-prescribing Practice has adopted and uses electronic prescribing and clinical decision support tools to improve the safety, quality, and cost-effectiveness of the prescription process 2 8 Preventive Services Primary prevention program is in place that focuses on identifying and educating patients about personal health behaviors to reduce their risk of disease and injury 8 9 Linkage to Community Services A comprehensive review of, and linkage to, community resources has been completed 8 10 Self-Management Support A systematic approach is in place to empower the patient to understand their central role in effectively managing their illness, making informed decisions about care, and engaging in healthy behaviors 8 11 Patient Web Portal A patient Web portal is in use by the practice to allow for electronic communication between patients and physicians, and to provide greater access to medical information and technical tools 12 12 Coordination of Care For patients with selected chronic conditions, a mechanism is established for being notified of each patient admission and discharge or other type of encounter, and appropriate transition plans are in place 9 13 Specialist Referral Process Procedures are in place to guide each phase of the specialist referral process 9 -
PCMH=patient-centered medical home.
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Note: The total number of capabilities is 128.
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↵a Details provided in Supplemental Appendix 2, available online only at http://annfammed.org/content/11/Suppl_1/S74/suppl/DC1.
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Mean Scorea December 2009, Practices With: June 2010, Practices With: Domain No. PCMH Domain December 2009 June 2010 All Capabilities, No. (%) ≥1 Capability, No. (%) All Capabilities, No. (%) ≥1 Capability, No. (%) 1 Patient-Provider Partnership 0.199 0.293 32 (1.3) 744 (29.9) 122 (4.9) 1,025 (41.2) 2 Patient Registry 0.167 0.266 2 (0.1) 991 (39.8) 36 (1.4) 1,340 (53.8) 3 Performance Reporting 0.195 0.296 7 (0.3) 937 (37.6) 85 (3.4) 1,292 (51.9) 4 Individual Care Management 0.196 0.325 1 (0.0) 1,349 (54.2) 1 (0.0) 1,876 (75.4) 5 Extended Access 0.296 0.448 44 (1.8) 1,393 (56.0) 76 (3.1) 1,954 (78.5) 6 Test Results Tracking & Follow-up 0.368 0.527 78 (3.1) 1,508 (60.6) 162 (6.5) 1,922 (77.2) 7 E-prescribing 0.456 0.601 1,108 (44.5) 1,162 (46.7) 1,477 (59.3) 1,514 (60.8) 8 Preventive Services 0.200 0.418 82 (3.3) 927 (37.2) 350 (14.1) 1,576 (63.3) 9 Linkage to Community Services 0.174 0.336 49 (2.0) 1,094 (44.0) 175 (7.0) 1,602 (64.4) 10 Self-Management Support 0.081 0.185 19 (0.8) 547 (22.0) 48 (1.9) 1,052 (42.3) 11 Patient Web Portal 0.063 0.103 1 (0.0) 699 (28.1) 6 (0.2) 1,139 (45.8) 12 Coordination of Care 0.074 0.200 26 (1.0) 740 (29.7) 121 (4.9) 1,257 (50.5) 13 Specialist Referral Process 0.160 0.367 26 (1.0) 886 (35.6) 122 (4.9) 1,634 (65.6) Total Overall score 0.181 0.313 0 (0.0) 1,892 (76.0) 1 (0.0) 2,225 (89.4) -
PCMH=patient-centered medical home.
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↵a Possible scores range from 0.0 (no implementation) to 1.0 (full implementation).
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- Table 3
Change in Implementation from December 2009 to June 2010 in Practices With Self-Reported Capabilities in Both Time Periods (N = 2,489)
Practices Whose PCMH Capabilities: Domain No. PCMH Domain Mean Change in Domain Score Expanded, No. (%) Retracted, No. (%) Remained the Same, No. (%) 1 Patient-Provider Partnership 0.095 603 (24.2) 1 (0.0) 1,885 (75.7) 2 Patient Registry 0.098 830 (33.3) 1 (0.0) 1,658 (66.6) 3 Performance Reporting 0.101 678 (27.2) 0 (0.0) 1,811 (72.8) 4 Individual Care Management 0.129 1,133 (45.5) 2 (0.1) 1,354 (54.4) 5 Extended Access 0.153 1,087 (43.7) 2 (0.1) 1,400 (56.2) 6 Test Results Tracking & Follow-up 0.159 882 (35.4) 2 (0.1) 1,605 (64.5) 7 E-prescribing 0.145 395 (15.9) 1 (0.0) 2,093 (84.1) 8 Preventive Services 0.219 1,121 (45.0) 1 (0.0) 1,367 (54.9) 9 Linkage to Community Services 0.162 985 (39.6) 2 (0.1) 1,502 (60.3) 10 Self-Management Support 0.104 698 (28.0) 2 (0.1) 1,789 (71.9) 11 Patient Web Portal 0.040 577 (23.2) 2 (0.1) 1,910 (76.7) 12 Coordination of Care 0.126 879 (35.3) 1 (0.0) 1,609 (64.6) 13 Specialist Referral Process 0.208 1,173 (47.1) 1 (0.0) 1,315 (52.8) Total Overall change score 0.133 1,855 (74.5) 2 (0.1) 632 (25.4) -
PCMH=patient-centered medical home.
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Supplemental Appendixes 1-2
Supplemental Appendix 1. PCMH Domains and Capabilities; Supplemental Appendix 2. Contextual Factors Relevant for Understanding and Transporting Study Findings
Files in this Data Supplement:
- Supplemental data: Appendix 1 - PDF file, 10 pages, 344 KB
- Supplemental data: Appendix 2 - PDF file, 2 pages, 188 KB
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