Article Figures & Data
Tables
Characteristic Facilitated Practices Self-Directed Practices P Value NDP = National Demonstration Project; PCMH = patient-centered medical home. Notes: Data are based on 35 practices that started the NDP; 1 of the original 36 practices was not able to obtain approval for the project from their institutional review board and withdrew their baseline data. a Values are percentages. b Values are ratings on a scale from 0 to 1, where higher values indicate a higher level of the attribute. Demographicsa n=17 n=18 Age of practice, y .22 ≤5 35 33 6–10 24 5 11–20 6 29 >20 35 33 Size .35 Solo (± midlevel clinicians) 35 22 Small (2–3 physicians) 24 12 Medium (4–6 physicians) 17 44 Large (≥7 physicians) 24 22 Setting .85 Rural 29 33 Suburban 53 55 Urban 18 11 Ownership structure .89 Physician owned 59 61 Health or hospital system owned 41 39 NDP model components in placea n=16 n=15 Access to care and information (overall, 6 items) 30 30 .92 Same-day appointments 44 53 .59 Group visits 6 7 .96 e-Visits 6 0 .32 Care management (overall, 4 items) 38 48 .22 Practice services (overall, 5 items) 95 91 .29 Continuity of care (overall, 5 items) 56 65 .25 Maternity care 81 87 .68 Hospital care 88 100 .16 Practice management (overall, 5 items) 42 59 .04 Quality and safety (overall, 5 items) 32 43 .19 Medication management 62 93 .04 Patient satisfaction feedback 44 53 .59 Health information technology (overall, 5 items) 28 31 .66 Electronic medical record 69 73 .78 Electronic prescribing 44 40 .83 Practice Web site 25 33 .61 Interactive patient portal 0 0 – Practice-based care teams (overall, 4 items) 20 48 .001 Patient-rated PCMH attributesb n=17 n=16 Comprehensive care .81 .84 .08 Coordination of care .74 .76 .53 Access to care .88 .88 .89 Personal relationship over time .76 .76 .58 Global practice experience .27 .32 .28 Component Items ACES = Ambulatory Care Experience Survey; CPCI = Components of Primary Care Index; PCMH = patient-centered medical home. Notes: Scores on this scale consisted of the average summed responses of the 23 items in 5 subscales. Cronbach α for the 23-item scale was .92. Comprehensive care (from CPCI18) Handles emergencies Care of almost any medical problem I may have Go for help with a personal or medical problem Go for care for an ongoing medical problem such as high blood pressure Go for a checkup to prevent illness Coordination of care (from CPCI18) Keeps track of all my health care Follows up on a problem I’ve had, either at the next visit or by mail, e-mail, or phone Follows up on my visit to other health care professionals Helps me interpret my laboratory tests, x-rays, or visits to other doctors Communicates with other health professionals I see Access to care (from ACES19) Help as soon as needed for an illness or injury Appointment for a checkup or routine care as soon as needed Answer to medical question the same day when calling during regular office hours Help or advice needed when calling after regular office hours Personal relationship over time (from CPCI18) Knows a lot about my family medical history Have been through a lot together Understands what is important to me regarding my health Knows my medical history very well Takes my beliefs and wishes into account in caring for me Knows whether or not I exercise, eat right, smoke, or drink alcohol Knows me well as a person (such as hobbies, job, etc) Global practice experience (new scale20) I receive the care I want and need when and how I want and need it I am delighted with this practice Component Items (Attributes Measured) Notes: Scores on this scale were computed as the summed averaged of the individual responses for each practice. Cronbach α for the 23-item scale was .97. Relationship infrastructure People in our practice actively seek new ways to improve how we do things (mindfulness) People at all levels of this office openly talk about what is and isn’t working (mindfulness) We regularly take time to consider ways to improve how we do things (mindfulness) People are aware of how their actions affect others in this practice (heedful interactions) Most people in this practice are willing to change how they do things in response to feedback from others (respectful interaction) After trying something new, we take time to think about how it worked (reflection) We regularly take time to reflect on how we do things (reflection) This practice encourages everyone (front office staff, clinical staff, nurses, and clinicians) to share ideas (cognitive diversity) I can rely on the other people in this practice to do their jobs well (trust) Difficult problems are solved through face-to-face discussions in this practice (communication) Facilitative leadership Practice leadership promotes an environment that is an enjoyable place to work Leadership in this practice creates an environment where things can be accomplished Leadership strongly supports practice change efforts The practice leadership makes sure that we have the time and space necessary to discuss changes to improve care Sensemaking When we experience a problem in the practice, we make a serious effort to figure out what’s really going on People in this practice have the information that they need to do their jobs well Teamwork I have many opportunities to grow in my work People in this practice operate as a real team Work environment Most of the people who work in our practice seem to enjoy their work This practice is a place of joy and hope Culture of learning Mistakes have led to positive changes here It is hard to get things to change in our practice This practice learns from its mistakes Outcome Facilitated Practices, Mean (SD) (n=16) Self-Directed Practices, Mean (SD) (n=15) ANOVA P Values ANOVA = analysis of variance; NDP = National Demonstration Project; PCMH = patient-centered medical home. Notes: Patient-rated PCMH and practice adaptive reserve are scale scores described in the text. ANOVA analyses were weighted by the number of respondents as a proxy for practice size. a The proportion of 39 measurable model components in place. b Scores represent the average summed responses for 23 items (shown in Table 2), with a range of 1 (strongly disagree) to 5 (strongly agree). Items were reverse-scored when appropriate so that higher numbers reflect more positive ratings. c Scores represent the average summed responses for 23 items (shown in Table 3). Items were reverse-scored when appropriate and rescaled to reflect a range from 0 to 1, where higher scores reflect more adaptive reserve. NDP model components in placea Baseline .42 (.40) .54 (.40) Between group: .19 26 months .72 (.45) .70 (.47) Within group: <.001 Group differences by time: .005 Patient-rated PCMHb Baseline 3.42 (0.66) 3.51 (0.75) Between group: .41 26 months 3.38 (0.68) 3.41 (0.93) Within group : .03 Group differences by time: .34 Practice adaptive reservec Baseline .69 (.35) .69 (.38) Between group: .51 26 months .74 (.38) .68 (.46) Within group: .09 Group differences by time: .02 Facilitated Practices (n=16) Self-Directed Practices (n=15) All Practices (N=31) Domain and Component In Place at Baseline Implemented During NDP Implemented in the 9 mo After NDP Not Implemented In Place at Baseline Implemented During NDP Implemented in the 9 mo After NDP Not Implemented In Place at Baseline Implemented During NDP Implemented in the 9 mo After NDP Not Implemented HR=human resources; NDP=National Demonstration Project. Notes: Values shown are numbers of practices. Within each group (facilitated, self-directed, or all), numbers total across rows. Access to care and information Same-day appointments 7 8 1 0 8 6 1 0 15 14 2 0 Laboratory results highly accessible 8 7 0 1 4 7 4 0 12 14 4 1 Online patient services 1 9 0 6 0 4 5 6 1 13 5 12 e-Visits 1 5 0 10 0 3 0 12 1 8 0 22 Group visits 1 8 2 5 1 5 0 9 2 13 2 14 After-hours access coverage 14 2 0 0 15 0 0 0 29 2 0 0 Care management Population management 2 6 0 8 2 4 3 6 4 10 3 14 Wellness promotion 4 3 0 9 5 1 0 9 9 4 0 18 Disease prevention 11 5 0 0 13 2 0 0 24 7 0 0 Patient engagement/education 7 5 0 4 9 3 1 2 16 8 1 6 Practice services Comprehensive acute and chronic care 16 0 0 0 15 0 0 0 31 0 0 0 Prevention screening 12 4 0 0 12 3 0 0 24 7 0 0 Surgical procedures 16 0 0 0 15 0 0 0 31 0 0 0 Ancillary therapeutic/support 16 0 0 0 12 3 0 0 28 3 0 0 Ancillary diagnostic services 16 0 0 0 14 1 0 0 30 1 0 0 Continuity of care Community-based services 7 3 0 6 8 1 0 6 15 4 0 12 Hospital care 14 0 0 2 15 0 0 0 29 0 0 2 Behavioral health care 8 1 0 7 8 2 0 5 16 3 0 12 Maternity care 13 0 0 3 13 0 0 2 26 0 0 5 Case management 3 3 0 10 5 1 1 8 8 4 1 18 Practice management Disciplined financial management 9 6 0 1 10 3 2 0 19 9 2 1 Cost-benefit decision making 9 2 2 3 10 5 0 0 19 7 2 3 Revenue enhancement 5 7 2 2 4 4 2 5 9 11 4 7 Personnel/HR management 8 6 1 1 12 2 1 0 20 8 2 1 Optimized office design 3 3 7 3 8 3 0 4 11 6 7 7 Quality and safety Medication management 10 3 0 3 14 1 0 0 24 4 0 3 Patient satisfaction feedback 7 3 0 6 8 3 0 4 15 6 0 10 Clinical outcomes analysis 4 5 0 7 4 4 1 6 8 9 1 13 Quality improvement 4 6 0 6 5 2 2 6 9 8 2 12 Practice-based team care 1 4 1 10 1 6 0 8 2 10 1 18 Health information technology Electronic medical record 11 3 0 2 11 3 0 1 22 6 0 3 Electronic prescribing 7 7 0 2 6 9 0 0 13 16 0 2 Population management/registry 0 7 0 9 1 3 3 8 1 10 3 17 Practice Web site 4 9 0 3 5 4 2 4 9 13 2 7 Interactive patient portal 0 5 2 9 0 4 5 6 0 9 7 15 Practice-based care teams Provider leadership 5 6 2 3 9 3 1 2 14 9 3 5 Shared mission and vision 3 7 1 5 9 2 1 3 12 9 2 8 Effective communication 3 7 2 4 9 2 1 3 12 9 3 7 Task designation by skill set 2 6 1 7 2 7 1 5 4 13 2 12
Additional Files
Supplemental Appendixes 1-2
Supplemental Appendix 1. National Demonstration Project Model Components; Supplemental Appendix 2. NDP Model Components Implemented by Practices in the Facilitated and Self-Directed Groups, and Overall
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file, 4 pages, 92KB
- Supplemental data: Appendix 2 - PDF file, 1 page, 89KB
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