Supporting Medical Home Transformation Through Evaluation of Patient Experience in a Large Culturally Diverse Primary Care Safety Net.

CONTEXT: The prevalence of chronic disease in the United States is rapidly increasing, with a disproportionate number of underserved, vulnerable patients sharing the burden. The Patient-Centered Medical Home (PCMH) is a care delivery model that has shown promise to improve primary care and address the burden of chronic illness. OBJECTIVE: The purpose of this study was to (1) understand patient characteristics that might influence perceived patient experience in a large primary care safety net undergoing PCMH transformation; (2) identify community-level quality improvement opportunities to support ongoing transformation activities; and (3) establish a baseline of patient experience across the primary care safety net that could be used in repeated evaluations over the course of transformation. DESIGN: A cross-sectional study design was used to conduct this research. SETTING AND PARTICIPANTS: A total of 351 racially and ethnically diverse patients of 4 primary care safety net organizations in Broward County, Florida, were surveyed regarding their experience with access to care and coordination of care. MAIN OUTCOME MEASURE: Reported access to care and coordination of care. RESULTS: Patients with chronic disease who reported having visited the clinic 3 or more times in the past 12 months reported a better coordination of care experience than patients who had fewer than 3 visits in the past 12 months (odds ratio = 3.57; 95% confidence interval, 1.76-7.24). Patients without chronic disease who had been receiving care at the clinic for 2 or more years of care reported worse experience with access to care than patients with less than 2 years of care (odds ratio = 0.26; 95% confidence interval, 0.11-0.60.) Race, ethnicity, language, and education were not significant predictors of patient experience. CONCLUSION: Findings support ongoing efforts to improve patient engagement among all patients and to enhance resources to manage chronic disease, including community-based self-management programs, in primary care safety nets undergoing PCMH transformation

Supporting medical home transformation through evaluation of patient experience in a large culturally diverse primary care safety net

Prevalence of chronic disease in the United States is rapidly increasing, with a disproportionate number of underserved, vulnerable patients sharing the burden. The Patient Centered Medical Home (PCMH) is a care delivery model that has shown promise to improve primary care and address the burden of chronic illness in the United States. We evaluated patient experience among primary care safety-net providers in Broward County, Florida in order to understand patient characteristics associated with experience and to identify opportunities that could support PCMH transformation among providers. As part of the study we surveyed 351 culturally and ethnically diverse patients. Findings suggest that having a chronic disease, a greater number of primary care visits in the past 12 months, and receiving a referral to a chronic disease workshop were positively associated with better patient experience. Our study also suggests that race, ethnicity, language, and education are not strong predictors of patient experience. These findings will be used to inform county-wide transformation activities including patient engagement and support for a community-based chronic disease self-management network