Measured Elements and Core Features of the Patient-Centered Medical Home (N = 342)
| Elements | Response No. (%) | Practices Awarded Point No. (%) |
|---|---|---|
| Elements of personal physician | 299 (87.4)a | |
| Continuity of care | 299 (87.4) | 299 (87.4), 1 point if yes |
| Elements of medical team | 80 (23.4)a | |
| Ancillary care clinicians | 119 (34.8), 1 point if yes to 3 or more questions | |
| Nurse(s) | 214 (62.6) | |
| Medical assistant(s) | 169 (49.4) | |
| Nurse-practitioner(s) | 149 (43.6) | |
| Patient educator(s) | 80 (23.4) | |
| Physician’s assistants | 67 (19.6) | |
| Mental health specialist(s) | 30 (8.8) | |
| Offer programs for employee morale/teamwork | 181 (52.9) | 181 (52.9), 1 point for yes |
| Elements of whole-person orientation | 254 (74.3)a | |
| Patient types seen | 260 (76.0), 1 point if yes to all | |
| Adults | 342 (100.0) | |
| Children | 316 (92.4) | |
| Infants | 260 (76.0) | |
| Type of care provided | 327 (95.6), 1 point if yes to all | |
| Preventive | 339 (99.1) | |
| Acute | 336 (98.2) | |
| Chronic illness | 333 (97.4) | |
| Elements of care coordination and integration | 12 (3.5)a | |
| Existence of patient registry | 66 (19.3), 1 point if yes to 3 or more questions | |
| Diabetes | 97 (28.2) | |
| Asthma | 73 (21.1) | |
| Congestive heart failure | 64 (18.5) | |
| Coronary artery disease | 64 (18.5) | |
| Depression | 58 (16.7) | |
| Other | 36 (10.6) | |
| Electronic medical record (EMR) components—internal coordination | 135 (39.5), 1 point for yes to 3 out of 6 questions | |
| Problem list | 133 (38.9) | |
| Ambulatory visits | 134 (39.2) | |
| Medication lists | 134 (39.2) | |
| Laboratory findings | 127 (37.1) | |
| Medication-ordering reminders, drug interaction | 107 (31.3) | |
| Radiology findings | 118 (34.5) | |
| EMR components—external coordination | 97 (28.4), 1 point for 2 out of 3 questions, | |
| Services by other specialists | 109 (31.9) | |
| Inpatient stays | 91 (26.6) | |
| Emergency room visits | 83 (24.3) | |
| Community linkages for care | 107 (31.3) | 107 (31.3), 1 point for yes |
| Linguistic services | 168 (49.1) | 168 (49.1), 1 point for yes |
| Elements of enhanced access | 124 (36.3)a | |
| Alternative scheduling arrangements | 124 (36.3), 1 point if yes to 3 or more questions | |
| Rapid access | 299 (87.4) | |
| Scheduled evenings or weekend visits | 134 (39.2) | |
| Telephone consultations | 134 (39.2) | |
| On-call evenings or weekends | 116 (33.9) | |
| E-mail consultations | 43 (12.6) | |
| Group visits | 34 (9.9) | |
| Elements of quality and safety | 60 (17.5)a | |
| Clinical guidelines | 223 (65.2), 1 point if yes to 2 or more questions | |
| Use of clinical guidelines | 263 (76.9) | |
| Physician training on clinical guidelines | 227 (66.4) | |
| EMR with problem-specific clinical guidelines | 64 (18.7) | |
| Patient satisfaction surveys | 133 (38.9), 1 point for yes to both questions | |
| Administers surveys | 163 (47.7) | |
| Initiates changes based on surveys | 136 (39.8) | |
| Performance measurement and monitoring | 97 (28.4), 1 point if yes to 2 or more questions | |
| Tracks clinician use of evidence-based guidelines | 80 (23.4) | |
| Tracks results of quality improvement projects | 81 (23.7) | |
| Tracks clinical outcomes | 80 (23.4) | |
| Provides written performance reports to physicians | 99 (28.9) |