Jonathan M. Birnberg, M.D., Melinda L. Drum, Ph.D., Elbert S. Huang, M.D., M.P.H., Lawrence P. Casalino, M.D.. Ph.D., Sarah E. Lewis, M.S.P.H., Anusha M. Vable, M.P.H., Hui Tang, M.S., Michael T. Quinn, Ph.D., Deborah L. Burnet, M.D., M.A., Thomas Summerfelt, Ph.D., and Marshall H. Chin, M.D., M.P.H.
Implementing the patient-centered medical home model in safety-net health care clinics may provide low-income and minority patients with access to high-quality, efficient care. However, the tools used to measure patient-centered medical home adoption are not appropriate for the safety-net setting because they do not fully cover relevant topics, like interpretation services. Moreover, the surveys are burdensome to complete and often are not publicly available. To bridge this gap, the authors of this study developed the Safety Net Medical Home Scale for evaluating patient-centered medical home interventions in safety-net clinics.
The new medical home scale assesses clinics on six domains: access to care and communication between provider and patient; patient tracking and registry; care management; medical test and referral tracking; quality improvement; and coordination. In testing the scale with 65 safety-net clinics throughout the United States, the authors found a mean summary score of 61 on the 100-point scale. Clinics scored highest on external coordination and access and communication and lowest on quality improvement and care management.
Analysis revealed that the clinics performed well in tracking laboratory tests, collecting and reporting clinical outcomes data at the provider level, and collecting patient satisfaction survey results at the group level. They scored lower on providing same-day or next-day appointments, generating a list of patients who are due for tests or preventive care, tracking specialist referrals, and arranging timely specialty appointments for uninsured and Medicaid patients.
The Safety Net Medical Home Scale is not difficult or burdensome for clinics to complete, yet still provides a thorough measurement of patient-centered medical home domains. In addition, the items capturing language services and care coordination for underserved patients will be particularly useful for evaluating interventions in safety-net clinics. The tool is available at http://www.commonwealthfund.org/publications/tools/2011/medical-home-adoption-in-the-safety-net.