The Association Among Medical Home Readiness, Quality, and Care of Vulnerable Patients

Objectives: Despite broad support for the patient-centered medical home (PCMH), the implications of PCMH implementation efforts that require that participants have some degree of PCMH readiness at baseline are unclear. Therefore, we sought to examine the association among PCMH readiness, quality, and the care of vulnerable patients.

Study Design: We conducted a cross-sectional study of adult visits to a nationally representative sample of US office-based primary care physicians in 2007 and 2008.

Methods: Using National Committee for Quality Assurance criteria, we determined whether or not a visit occurred at a PCMH-ready practice. We used t tests and multiple linear regression to measure the association between PCMH readiness and performance on 9 validated outpatient quality indicators.

Results: Among 12,235 visits to general practitioners and 5123 visits to general internists, 73% occurred at practices that were PCMH-ready. Visits by patients with 3 or more chronic medical conditions were more likely to occur at ready practices (P = .001). Visits by patients that were poor or minority were equally likely to occur at ready and unready practices. Performance at ready practices was higher for 3 of 9 quality indicators related to chronic disease management and preventive counseling (P = .031 [beta-blocker or diuretic prescribed for hypertension]; P = .018 [diet counseling]; and P <.001 [exercise counseling]).
 

Conclusions: Implementation efforts that encourage the enrollment of practices most ready for the PCMH could improve the quality of care for complex patients without exacerbating socioeconomic disparities in access to care.