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28.01.2020 | Original Research

Components of the Patient-Centered Medical Home Associated with Perceived Access to Primary Care

verfasst von: Linnaea Schuttner, MD, MS, Eric Gunnink, MS, Philip Sylling, MA, Leslie Taylor, PhD, Stephan D. Fihn, MD, MPH, Karin Nelson, MD, MSHS

Erschienen in: Journal of General Internal Medicine | Ausgabe 6/2020

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Abstract

Background

Following implementation of the patient-centered medical home (PCMH) within the Department of Veterans Affairs (VA), access to primary care improved. However, understanding of how this occurred is lacking.

Objective

To examine the association between organizational aspects of the PCMH model and access-related initiatives with patient perception of access to urgent, same-day, and routine care within the VA.

Design

Cross-sectional

Participants

Veterans who responded to the annual Survey of Healthcare Experiences of Patients in 2016 (N = 241,122 patients) and primary staff who responded to VA National Primary Care Provider and Staff Survey (N = 4815 staff).

Main Measures

Three outcomes of perception of access: percentage of patients responding in the highest category for same-day care (waiting ≤ 1 day), urgent care (always receiving care when needed), and routine care (always receiving checkups when desired). Predictors were staff-level report of access-related initiatives and organizational factors in the clinic. We used generalized estimating equations to model associations, adjusting for characteristics of patients and their respective clinics.

Key Results

Access was significantly better in clinics where staff reviewed performance reports (+ 0.9% in the highest perception of access for urgent care, P < 0.01; + 1.2% for routine care, P < 0.001), leadership was supportive of the PCMH (+ 1.6% for urgent care, P < 0.01), and initiatives to improve access included open access (+ 0.8% to + 1.7% across all outcomes, P < 0.01) and telehealth visits (+ 1.2% to + 1.4%, P < 0.001). Perceived access was worse in clinics with moderate staff burnout (− 1.1% to − 1.4%, P < 0.001), primary care provider turnover during the past year (− 1.0% to − 1.6%, P < 0.001), or medical support assistant turnover in the past year (− 0.9% to − 1.4%, P < 0.001).

Conclusions

Perception of access was strongly associated with identifiable organizational factors and access-related initiatives within VA primary care clinics that could be adopted by other health systems.

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Titel: Components of the Patient-Centered Medical Home Associated with Perceived Access to Primary Care
verfasst von: Linnaea Schuttner, MD, MS
Eric Gunnink, MS
Philip Sylling, MA
Leslie Taylor, PhD
Stephan D. Fihn, MD, MPH
Karin Nelson, MD, MSHS
Publikationsdatum: 28.01.2020
Verlag: Springer International Publishing
Erschienen in: Journal of General Internal Medicine / Ausgabe 6/2020
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-020-05668-7

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Components of the Patient-Centered Medical Home Associated with Perceived Access to Primary Care

Abstract

Background

Objective

Design

Participants

Main Measures

Key Results

Conclusions

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Abstract

Background

Objective

Design

Participants

Main Measures

Key Results

Conclusions

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