Approximately 24 million Americans are living with diabetes. Patient activation among individuals with diabetes is critical to successful diabetes management. The Patient Centered Medical Home (PCMH) model holds promise for increasing patient activation in managing their health. However, what is not well understood is the extent to which individual components of the PCMH model, such as the quality of physician-patient interactions and organizational features of care, contribute to patient activation. This study’s objective is to determine the relative importance of the PCMH constructs or domains to patient activation among individuals living with diabetes.
This study is a cross-sectional analysis of 1253 primary care patients surveyed with type II diabetes. The dependent variable, patient activation, was assessed using the Patient Activation Measure (PAM). Independent variables included 7 PCMH domains- organizational access, integration of care, comprehensive knowledge, office staff helpfulness, communication, interpersonal treatment and trust. Ordered logistic regression was performed to determine whether each PCMH domain was independently associated with patient activation, followed by a final ordered logistic regression that included all the PCMH domains in a single adjusted model.
Using the full adjusted model, the odds of patients reporting higher activation scores (PAM) were found to be significant in the domains that represented organizational access (OR 1.56, 95% CI 1.31–1.85) and comprehensive knowledge (OR 1.44, 95% CI 1.13–1.85).
Many practices have struggled with the challenge to develop fully functional patient-centered medical homes. In an effort to become more patient-centered, this study aimed to address what factors activated diabetic patients to adhere to diabetes management plan. Understanding these factors can help identify PCMH attributes that practices can prioritize and improve upon to assist their patients in improving health outcomes.
Study was not a clinical trial; therefore it was not registered.
National Committee on Quality Assurance. Patient-centered medical home. 2014. http://www.ncqa.org/Portals/0/Programs/Recognition/PCMH/PCMH-2014_Brochure-web-1.pdf. Accessed 2 Dec 2015.
Nielsen M, Langner B, Zema C, Hacker T, and Grundy P. Benefits of implementing the primary care patient-centered medical home: a review of cost & quality results, patient-centered primary care collaborative. 2012. https://www.pcpcc.org/guide/benefits-implementing-primary-care-medical-home. Accessed 20 Dec 2015.
Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998;1:2–4. PubMed
Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39(4):1005–10026. doi: https://doi.org/10.1111/j.1475-6773.2004.00269.x. CrossRefPubMedPubMedCentral
Remmers C, Hibbard J, Mosen DM, Wagenfield M, Hoye RE, Jones C. Is patient activation associated with future health outcomes and healthcare utilization among patients with diabetes? J Ambul Care Manage. 2009;32(4):1–8. doi: https://doi.org/10.1097/JAC.0b013e3181ba6e77. CrossRef
Center for Advancing Health. 2010. “A new definition of patient engagement: what is engagement and why is it important?”. Available at http://www.cfah.org/pdfs/CFAH_Engagement_Behavior_Framework_current.pdf. Accessed 15 June 2017.
Hibbard JH, Mahoney ER, Stockard J, Tusler M. Development and testing of a short form of the patient activation measure. Health Serv Res. 2005;40:1918–30. doi: https://doi.org/10.1111/j.1475-6773.2005.00438.x. CrossRefPubMedPubMedCentral
Green CA, Perrin NA, Polen MR, Leo MC, Hibbard JH, Tusler M. Development of the patient activation measure for mental health. Admin Pol Ment Health. 2010;37(4):327–33. CrossRef
Skolasky RL, Green AF, Scharfstein D, Boult C, Reider L, Wegener ST. Psychometric properties of the patient activation measure among multimorbid older adults. Health Serv Res. 2011;46(2):457–78. doi: https://doi.org/10.1111/j.1475-6773.2010.01210.x. CrossRefPubMedPubMedCentral
Rademakers J, Nijman J, van der Hoek L, Heijmans M, Rijken M. Measuring patient activation in the Netherlands: translation and validation of the American short form patient activation measure (PAM13). BMC Public Health. 2012;12(1):577. doi: https://doi.org/10.1186/1471-2458-12-577. CrossRefPubMedPubMedCentral
Safran DG, Karp M, Coltin K, et al. Measuring patients’ experiences with individual primary care physicians. Results of a statewide demonstration project. J Gen Intern Med. 2006;21:13–21. doi: https://doi.org/10.1111/j.1525-1497.2005.00311.x. CrossRefPubMedPubMedCentral
Nocon RS, Gao Y, Gunter KE, Jin J, Casalino LP, Quinn MT, Derrett S, Summerfelt WT, Huang ES, Lee SM, Chin MH. Associations between medical home characteristics and support for patient activation in the safety net: understanding differences by race, ethnicity, and health status. Med Care. 2014;52(11 Suppl 4):S48–55. CrossRefPubMedPubMedCentral
Reid RJ, Coleman K, Johnson EA, et al. The group health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers. Health Aff (Millwood). 2010;29(5):835–43. CrossRef
Camacho F, Anderson RT, Safrit A, Jones AS, Hoffmann P. The relationship between patient's perceived waiting time and office-based practice satisfaction. NC Med J. 2006;67:409–13.
- Key attributes of patient centered medical homes associated with patient activation of diabetes patients
Lori A. Bilello
Jon C. Mills
- BioMed Central
Neu im Fachgebiet Allgemeinmedizin
Meistgelesene Bücher aus dem Fachgebiet
e.Med Kampagnen-Visual, Mail Icon II