Article Figures & Data
Tables
Characteristic Value Cliniciansa (full and part time), mean (SD), No. 1.96 (1.75) Solo clinicians, % 67 Other staff (full and part time), mean (SD), No. 4.77 (3.67) Annual patient visits, mean (SD), No. 6,791 (6,106) Patients, mean (SD), No. 2,413 (2,683) Patients best served in another language, % (SD) 32 (31) Uninsured patients, % (SD) 11 (20) Patients with Medicaid coverage, % (SD) 42 (29) Nonwhite patients, % (SD) 66 (32) Affiliations before joining PCIP, %b Network(s) of outpatient practices that share resources for managing patient care 5 Independent Practice Association(s) 30 Hospital(s) over and above admitting/attending privileges 11 Financially and/or contractually linked network(s) 1 Academic medical center(s) 4 Faith-based institution(s) 1 Community-based institution(s) 1 Other entity/entities or system(s) 1 No prior affiliation(s) 51 Self-reported financial viability, % Able to acquire equipment and staff as needed: Strongly disagree 10 Disagree 26 Agree 47 Strongly agree 17 Worry about meeting monthly expenses: Strongly disagree 8 Disagree 22 Agree 42 Strongly agree 29 - Table 2
Practices’ Previous Experience With Aspects of the Patient-Centered Medical Home (N=94)
Experience Practices, % Had computers 88 Had an electronic health record in place 21 Used a management system 37 Used a patient registry 17 Electronically transmitted prescriptions 18 Had implemented quality improvement activity/activities 26 PCMH Characteristic Percent or Mean (SD) Dimension 1: Each patient has a personal physician Patients usually/always see the same cliniciana 90 All patients in the practice can identify their primary care clinician or care team by name 57 Dimension 2: Whole-person orientation Clinician includes an adult patient’s family in discussion of his/her health Never/rarely 7 Sometimes 49 Usually 34 Always 10 Clinician discusses diet and exercise guidelines with patients Never/rarely 0 Sometimes 2 Usually 37 Always 61 Clinician discusses depression with patients Never/rarely 0 Sometimes 19 Usually 53 Always 28 Clinician discusses stress and anxiety with patients Never/rarely 0 Sometimes 20 Usually 54 Always 26 Clinician discusses alternative treatments with patients Never/rarely 17 Sometimes 43 Usually 20 Always 20 Clinician discusses family planning or birth control services with patients Never/rarely 18 Sometimes 42 Usually 21 Always 19 Resources used for translation with patients who cannot communicate well in English Family member 63 On-site bilingual clinical staff 62 On-site bilingual nonclinical staff 17 Telephone-based translation service 6 Languages in which patient education materials are made available English 96 Spanish 68 Other 20 Amount of formal training that practice staff have used to improve their skills in patient communication or cultural competence Little or none 47 Some 29 Great deal 18 Dimension 3: Team-based care Formal care teams in place 18 Informal care teams in place 57 Nonclinician staff educate patients about prevention, chronic illness, and/or depression 43 Practice staff meet to review and plan care for individual patients Daily 10 At least weekly 10 At least monthly 33 Less than monthly 47 Practice holds all-staff meetings Never 15 Once a year 12 Once a quarter 29 Monthly 34 Weekly 10 Practice staff have “huddle” meetings in which operational strategies and/or division of labor is determined 45 Nonclinician staff provide patient education Never/rarely 28 Sometimes 42 Usually 16 Always 10 Nonclinician staff take patient history Never/rarely 45 Sometimes 23 Usually 12 Always 16 Nonclinician staff perform chronic disease screening Never/rarely 70 Sometimes 16 Usually 7 Always 2 Clinicians speak to primary care clinicians outside of their practices about cases Never/rarely 21 Sometimes 49 Usually 19 Always 11 Dimension 4: Care coordinated and integrated across health care system Designated care or case manager 7 Nondesignated staff functioning as care or case manager 55 Use electronic prescribing 94 Have structured processes in place for: Reminding patients of upcoming appointments 87 Following up with patients who have missed appointments 81 Contacting patients who have not been seen in ≥1 year 59 Systematically monitoring patients with chronic conditions 82 Clinician shares clinical information with specialists Never/rarely 1 Sometimes 18 Usually 39 Always 42 Clinician follows up directly with specialists if aware of visit Never/rarely 0 Sometimes 42 Usually 35 Always 23 Clinician talks with patients about the results of their visit(s) to specialist(s) Never/rarely 1 Sometimes 9 Usually 31 Always 59 Clinician finds out their patients are in the hospital during their hospitalizations Never/rarely 2 Sometimes 27 Usually 50 Always 21 Clinician sees patients during their hospitalizations Never/rarely 36 Sometimes 24 Usually 14 Always 24 Clinician receives discharge summary for patients who have been hospitalized Never/rarely 3 Sometimes 23 Usually 47 Always 27 Practice refers patients to community smoking cessation programs Never/rarely 14 Sometimes 44 Usually 19 Always 23 Practice refers patients to community diabetes education Never/rarely 9 Sometimes 31 Usually 29 Always 31 Practice refers patients to community mental or behavioral health counseling Never/rarely 5 Sometimes 36 Usually 32 Always 27 Practice refers patients to community patient support groups Never/rarely 26 Sometimes 44 Usually 17 Always 12 Have developed QI process(es) to improve patient satisfaction 57 Dimension 5: Focus on quality and safety Practice has clinical care guidelines for preventive care No 5 Yes, without using EHR 32 Yes, using EHR 63 Practice has clinical care guidelines for ≥1 chronic diseases No 7 Yes, without using EHR 32 Yes, using EHR 63 Practice has clinical care guidelines for depression No 11 Yes, without using EHR 26 Yes, using EHR 63 Practice uses a formal process to measure performance of individual clinicians 29 Practice uses a formal process to measure performance of the entire practice 34 Practice has developed a plan for improving patient care processes or outcomes 40 Practice has used clinical data to assess the impact of QI efforts 55 Practices uses PDSA or rapid cycle testing 9 Amount of time clinician spends on patient education during a typical visit A little 8 A moderate amount 54 A lot 38 Dimension 6: Timely access to care and communication Clinicians communicate with patients via e-mail 37 Use open access or advanced access scheduling 61 Business days a patient with nonurgent needs will wait to see their clinician, No. 1 (0.2) In-office wait time for scheduled appointments, min 28 (16) Clinicians can respond to patients who call outside of regular office hours Never/rarely 5 Sometimes 4 Usually 18 Always 72 Clinicians can return patient calls about medical issues received during office hours by the end of that same day Never/rarely 1 Sometimes 1 Usually 27 Always 71 Practice arrangements for patients to see a doctor or nurse for nonemergent problems on evenings and/or weekends without going to the emergency department Practice is open some evenings and/or weekends 68 Have made arrangements with other practices 4 Have made arrangements with ≥1 urgent care center(s) 5 Other 17 No specific arrangements 14 PCMH recognition and related incentives Have not applied for PCMH recognition 32 Application pending 19 Receiving medical home/PCMH incentives 38 Receiving HIT/meaningful use incentives 59 Receiving QI/performance incentives from health plan 27 -
EHR = electronic health record; HIT = health information technology; PCMH = patient-centered medical home; PDSA = Plan, Do, Study, Act; QI = quality improvement.
-
Note: Clinicians refers to medical doctors, doctors of osteopathy, nurse practitioners, or physician assistants.
-
↵a Question asked only of respondents who identified themselves as not solo practitioners as it was assumed that in a solo practice patients would necessarily seem the same physician every time.
-
Additional Files
Supplemental Appendix
Supplemental Appendix. Contextual Factors Relevant for Understanding and Transporting Findings
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file, 3 pages, 225 KB
