Article Figures & Data
Tables
Characteristic No. or Mean (SD) Range Location Urban 6 – Suburban 15 – No. of clinicians Primary care MDs 9.3 (3.8) 3–17 Primary care NPs/PAs 2.0 (1.6) 0–6 Patient insurance, % Commercial 58.1 (10.6) 27.0–70.6 Medicare 11.7 (6.1) 4.9–33.4 State programsa 11.3 (8.1) 3.2–38.3 Dual 0.7 (1.0) 0–3.8 Self 1.9 (0.5) 1.0–3.2 Other 16.2 (2.6) 11.7–20.2 No. of active patients 10,377.9 (3,678.2) 4,358–19,783 Patient demographics, % Female 56.5 (10.0) 50.8–98.6 Age, years <18 24.3 (10.4) 1–38.9 18–64 63.2 (8.8) 48.6–90.6 >64 11.6 (5.5) 4.9–30.9 White 68.8 (17.9) 19–93.4 English language preference 95.5 (6.7) 69.0–99.8 -
HPMG=HealthPartners Medical Group; MD=medical doctor; NP=nurse practitioner; PA=physician assistant.
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↵a Medicaid, Minnesota Care (for uninsurable patients).
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2006 2009 Question Meana Range Meana Range Yearly Changeb P Value Able to get appointment when wanted 92.5 81.7–98.3 95.2 91.3–99.1 +0.9 <.01 Confidence/trust in clinician 88.8 82.5–96.5 89.4 78.4–96.7 +0.4 .20 Treated with dignity/respect 96.0 90.9–100 97.3 92.4–100 +0.6 <.01 Received enough information 81.3 69.6–89.7 82.6 72.6–91.6 +0.3 .41 Received timely test results 79.6 68.2–94.4 83.9 69.1–93.5 +1.8 <.01 Knew who to call for help after appointment 93.3 83.5–97.4 95.8 92.5–100 +1.0 .16 Would recommend this clinic 79.1 61.8–91.0 80.9 67.4–89.0 +0.8 .10 -
HPMG=HealthPartners Medical Group.
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↵a Unadjusted percentages of patients who gave the top rating (Yes or Yes completely, depending on question).
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↵b Estimated using a model that adjusted for the following year-specific, clinic-level variables related to case mix: number of active patients, proportion of active patients covered by Medicaid, and proportions that were female, white, and aged 65 years or older.
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- Table 3
Comparison of Changes in Consumer Choice Satisfaction Ratings, HPMG vs Non-HPMG Medical Groups
HPMG (n=1) Non-HPMG (n=19) Question 2005a 2009a Yearly Changeb 2005a 2009a Yearly Changeb P Valuec Very satisfied with clinic 35.7 56.3 +4.9 55.3 57.0 +0.7 <.01 Would definitely recommend clinic 47.1 66.1 +5.2 64.4 66.7 +1.2 <.01 Very satisfied with ability to get medical advice after hours 29.9 37.4 +2.2 28.1 29.3 +0.3 .18 Very satisfied with ability to schedule convenient appointment 32.9 46.1 +2.8 45.5 45.5 +0.3 .03 Very satisfied with ease of seeing doctor of your choice 36.3 48.1 +3.5 47.5 48.6 +0.6 .02 Very satisfied with how well listened to 47.0 56.0 +2.2 58.5 59.2 +0.2 .11 Very satisfied with advice on how to stay healthy 34.6 40.8 +0.9 47.0 46.8 −0.02 .43 -
HPMG=HealthPartners Medical Group.
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↵a Unadjusted mean percentages of patients who gave the top rating (Yes or Yes completely, depending on question).
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↵b Estimated using a model that adjusted for the following year-specific, medical group–level variables related to patient case mix: number of patient visits per week, proportion covered by Medicaid, proportion female, mean age of patients, mean number of primary care visits per year, and mean number of medications prescribed.
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↵c For difference between slopes over time.
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HPMG Non-HPMG Measurea No. of Groups Baselineb Last Yearb Yearly Changec No. of Groups Baselineb Last Yearb Yearly Changec P Valued Optimal diabetes care 1 18.1 23.5 +3.1 19 14.6 18.6 +1.8 .42 Optimal CAD care 1 36.8 50.0 +7.4 19 34.3 37.2 +1.2 .12 Composite preventive services 1 69.6 81.3 +4.2 21 72.6 77.1 +1.5 .26 Generic drug use 1 37.4 49.7 +2.9 34 31.7 46.9 +3.4 <.01 -
CAD = coronary artery disease; HPMG = HealthPartners Medical Group.
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↵a Quality measures assessed in 2005 and 2007 (optimal diabetes care and optimal CAD care), 2006 and 2009 (composite preventive services), and 2005 and 2009 (generic drug use).
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↵b Unadjusted mean values.
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↵c Estimated using a model that adjusted for the following year-specific, patient-level variables: sex, Medicaid status, age, number of primary care visits per year, and number of medications prescribed.
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↵d For the difference between slopes.
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Additional Files
Supplemental Tables
Supplemental Table 1. Detailed Data for Changes in Consumer Choice Satisfaction for the 19 Non-HPMG Medical Groups; Supplemental Table 2. Detailed Data for Changes in Quality in Non-HPMG Medical Groups
Files in this Data Supplement:
- Supplemental data: Tables 1-2 - PDF file, 2 pages, 152KB
The Article in Brief
Trends in Quality During Medical Home Transformation
Leif I. Solberg, and colleagues
Background Many primary care practices are striving to transform themselves into patient-centered medical homes (PCMHs). How does the transformation to a PCMH affect quality of care? This study looks at changes in technical quality and patient experience as primary care clinics transform themselves into patient-centered medical homes.
What This Study Found Transformation to a PCMH is associated with improvements in quality and patient satisfaction, but the rate of improvement is slow. In this study, practices had a 1% to 3% per year increase in patient satisfaction and a 1% to 4% per year increase in performance on quality measures for diabetes, coronary artery disease, preventive services, and generic medication use. When compared with other medical groups in the region, the rates of increase were greater for satisfaction, but similar for the quality measures.
Implications
- In the transformation to a PCMH, expectations for large and rapid improvements in health or patient experience are probably unrealistic.
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