Bradley Michael Gray, Ph.D., Weifeng Weng, Ph.D., and Eric S. Holmboe, M.D.
B. M. Gray, W. Weng, and E. S. Holmboe, "An Assessment of Patient-Based and Practice Infrastructure–Based Measures of the Patient-Centered Medical Home: Do We Need to Ask the Patient?" Health Services Research, published online Aug. 11, 2011.
The patient-centered medical home, a model of primary care delivery intended to provide enhanced access to services together with care coordination, is being tested in demonstration projects across the United States. In determining whether physician groups qualify as medical homes, both Medicare and private insurers use a tool that focuses almost exclusively on a practice's infrastructure—an approach that neglects to assess patient experience.
The National Committee for Quality Assurance has proposed an optional patient-experience component to the qualifying process. The authors, using patient surveys and chart reviews, sought to examine the importance of both patient-based and practice infrastructure measures of the patient-centered medical home.
The study, supported by The Commonwealth Fund, suggests that patient-centered care measures, such as short waiting times and access to care when needed, in addition to practice infrastructure capabilities, may help predict health outcomes. The authors note that both a high practice-infrastructure score and strong patient ratings for care quality were associated with improvements in blood pressure control, a key gauge of health outcomes.
Patient-centered care measures were the prime determinants of patient ratings of physician quality. Having all patient-centered care measures in place, versus none, increased the likelihood of a top physician rating by more than 75 percent. These results imply the use of patient-centered care measures is associated with higher physician ratings, which in turn predict better blood pressure control.
An assessment tool that relies solely on either practice infrastructure or patient rating of care will probably miss important determinants of actual care quality, the authors conclude. The review of physician practices for patient-centered medical home qualification should consider both patient-based and practice infrastructure–based measures.