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Journal of Community Health

, Volume 42, Issue 2, pp 303–311 | Cite as

Medical Home Characteristics and Quality of Diabetes Care in Safety Net Clinics

  • Kathryn E. Gunter
  • Robert S. Nocon
  • Yue Gao
  • Lawrence P. Casalino
  • Marshall H. Chin
Original Paper

Abstract

We examined associations between patient-centered medical home (PCMH) characteristics and quality of diabetes care in 15 safety net clinics in five states. Surveys among clinic directors assessed PCMH characteristics using the Safety Net Medical Home Scale. Chart audits among 864 patients assessed diabetes process and outcome measures. We modeled the odds of the patient receiving performance measures as a function of total PCMH score and of PCMH subscales and covariates. PCMH characteristics had mixed, inconsistent associations with the quality of diabetes care. The PCMH model may require refinement in design and implementation to improve diabetes care among vulnerable populations.

Keywords

Patient-centered medical home Quality Primary care Safety net Diabetes 

Notes

Funding

Financial support for the study was provided by The Commonwealth Fund. Dr. Chin was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (K24 DK071933 and P30 DK092949). Mr. Nocon was supported by an Agency for Healthcare Research and Quality training grant (T32 HS000084).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

References

  1. 1.
    Adashi, E. Y., Geiger, H. J., & Fine, M. D. (2010). Health care reform and primary care: The growing importance of the community health center. New England Journal of Medicine, 362(22), 2047–2050.CrossRefPubMedGoogle Scholar
  2. 2.
    Agency for Healthcare Research and Quality. (2012). U.S. Department of Health and Human Services. 2012 National health care quality report. AHRQ Publication NO. 13–0002. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from http://www.ahrq.gov/research/findings/nhqrdr/nhqr12/2012nhqr.pdf.
  3. 3.
    Alexander, J. A., & Bae, D. (2012). Does the patient-centred medical home work? A critical synthesis of research on patient-centred medical homes and patient-related outcomes. Health Services Management Research, 25(2), 51–59.CrossRefPubMedGoogle Scholar
  4. 4.
    Ali, M. K., Bullard, K. M., Saaddine, J. B., Cowie, C. C., Imperatore, G., & Gregg, E. W. (2013). Achievement of goals in US diabetes care, 1999–2010. New England Journal of Medicine, 368(17), 1613–1624.CrossRefPubMedGoogle Scholar
  5. 5.
    Birnberg, J. M., Drum, M. L., Huang, E. S., Casalino, L. P., Lewis, S. E., Vable, A. M., … & Chin, M. H. (2011). Development of a safety net medical home scale for clinics. Journal of General Internal Medicine, 26(12), 1418–1425.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Bloom, F. J. Jr., & Graf, T. (2010). Redesign of a diabetes system of care using an all-or-none diabetes bundle to build teamwork and improve intermediate outcomes. Diabetes Spectrum, 23(3), 165.CrossRefGoogle Scholar
  7. 7.
    Bojadzievski, T., & Gabbay, R. A. (2011). Patient-centered medical home and diabetes. Diabetes Care, 34(4), 1047–1053.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Calman, N. S., Hauser, D., Weiss, L., Waltermaurer, E., Molina-Ortiz, E., Chantarat, T., & Bozack, A. (2013). Becoming a patient-centered medical home: a 9-year transition for a network of federally qualified health centers. The Annals of Family Medicine, 11(Suppl 1), S68–S73.CrossRefPubMedGoogle Scholar
  9. 9.
    Casagrande, S. S., Fradkin, J. E., Saydah, S. H., Rust, K. F., & Cowie, C. C. (2013). The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988–2010. Diabetes Care, 36(8), 2271–2279.CrossRefGoogle Scholar
  10. 10.
    Centers for Medicare and Medicaid Services. (2010). Federally qualified health center advanced primary care practice demonstration. Retrieved from https://innovation.cms.gov/initiatives/FQHCs/index.html.
  11. 11.
    Clarke, R. M., Tseng, C. H., Brook, R. H., & Brown, A. F. (2012). Tool used to assess how well community health centers function as medical homes may be flawed. Health Affairs, 31(3), 627–635.CrossRefPubMedGoogle Scholar
  12. 12.
    Cook, N. L., Hicks, L. S., O’Malley, A. J., Keegan, T., Guadagnoli, E., & Landon, B. E. (2007). Access to specialty care and medical services in community health centers. Health Affairs, 26(5), 1459–1468.CrossRefPubMedGoogle Scholar
  13. 13.
    Doty, M. M., Abrams, M. K., Hernandez, S. E., Stremikis, K., & Beal, A. C. (2010). Enhancing the capacity of community health centers to achieve high performance. New York: The Commonwealth Fund.Google Scholar
  14. 14.
    Friedberg, M. W., Schneider, E. C., Rosenthal, M. B., Volpp, K. G., & Werner, R. M. (2014). Association between participation in a multipayer medical home intervention and changes in quality, utilization, and costs of care. JAMA, 311(8), 815–825.CrossRefPubMedGoogle Scholar
  15. 15.
    Gabbay, R. A., Bailit, M. H., Mauger, D. T., Wagner, E. H., & Siminerio, L. (2011). Multipayer patient-centered medical home implementation guided by the chronic care model. The Joint Commission Journal on Quality and Patient Safety, 37(6), 265–273.CrossRefPubMedGoogle Scholar
  16. 16.
    Health Resources and Services Administration. HRSA accreditation and patient-centered medical home recognition initiative. Retrieved from http://bphc.hrsa.gov/qualityimprovement/clinicalquality/accreditation-pcmh.
  17. 17.
    Hochman, M. E., Chen, A. Y., & Serota, M. (2013). A view from the safety net. JAMA, 309(21), 2221–2222.CrossRefPubMedGoogle Scholar
  18. 18.
    Holmboe, E. S., Arnold, G. K., Weng, W., & Lipner, R. (2010). Current yardsticks may be inadequate for measuring quality improvements from the medical home. Health Affairs, 29(5), 859–866.CrossRefPubMedGoogle Scholar
  19. 19.
    Jackson, G. L., Powers, B. J., Chatterjee, R., Bettger, J. P., Kemper, A. R., Hasselblad, V., … & Gray, R. (2013). The patient-centered medical home: a systematic review. Annals of Internal Medicine, 158(3), 169–178.CrossRefPubMedGoogle Scholar
  20. 20.
    Katz, M. H. (2010). Future of the safety net under health reform. JAMA, 304(6), 679–680.CrossRefPubMedGoogle Scholar
  21. 21.
    Ku, L., Jones, E., Shin, P., Byrne, F. R., & Long, S. K. (2011). Safety-net providers after health care reform: Lessons from Massachusetts. Archives of Internal Medicine, 171(15), 1379–1384.CrossRefPubMedGoogle Scholar
  22. 22.
    MN Community Measurement. (2009). MNCM measurement specifications for optimal diabetes care. Retrieved from http://www.health.state.mn.us/healthreform/measurement/2010DDSSpecsDIABETES.pdf.
  23. 23.
    National Committee for Quality Assurance. (2008). Standards and guidelines for physician practice connections: Patient-centered medical home. Retrieved from http://www.ncqa.org/Portals/0/Programs/Recognition/PCMH_Overview_Apr01.pdf.
  24. 24.
    Nocon, R. S., Sharma, R., Birnberg, J. M., Ngo-Metzger, Q., Lee, S. M., & Chin, M. H. (2012). Association between patient-centered medical home rating and operating cost at federally funded health centers. JAMA, 308(1), 60–66.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Nolan, T., & Berwick, D. M. (2006). All-or-none measurement raises the bar on performance. JAMA, 295(10), 1168–1170.CrossRefPubMedGoogle Scholar
  26. 26.
    Norris, S. L., Chowdhury, F. M., Le, K. V., Horsley, T., Brownstein, J. N., Zhang, X., … Satterfield, D. W. (2006). Effectiveness of community health workers in the care of persons with diabetes. Diabetic Medicine, 23(5), 544–556. doi: 10.1111/j.1464-5491.2006.01845.x.CrossRefPubMedGoogle Scholar
  27. 27.
    Peek, M. E., Cargill, A., & Huang, E. S. (2007). Diabetes health disparities: a systematic review of health care interventions. Medical Care Research and Review, 64 (Suppl 5), 101S–156S.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Rosenthal, M. B., Friedberg, M. W., Singer, S. J., Eastman, D., Li, Z., & Schneider, E. C. (2013). Effect of a multipayer patient-centered medical home on health care utilization and quality: the Rhode Island chronic care sustainability initiative pilot program. JAMA Internal Medicine, 173(20), 1907–1913.Google Scholar
  29. 29.
    Shi, L., Lock, D. C., Lee, D. C., Lebrun-Harris, L. A., Chin, M. H., Chidambaran, P., … & Sripipatana, A. (2015). Patient-centered medical home capability and clinical performance in HRSA-supported health centers. Medical Care, 53(5), 389–395.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Solberg, L. I., Klevan, D. H., & Asche, S. E. (2007). Crossing the quality chasm for diabetes care: the power of one physician, his team, and systems thinking. The Journal of the American Board of Family Medicine, 20(3), 299–306.Google Scholar
  31. 31.
    Solberg, L. I., Asche, S. E., Fontaine, P., Flottemesch, T. J., Pawlson, L. G., & Scholle, S. H. (2011). Relationship of clinic medical home scores to quality and patient experience. The Journal of Ambulatory Care Management, 34(1), 57–66.CrossRefPubMedGoogle Scholar
  32. 32.
    Solberg, L. I., Crain, A. L., Tillema, J., Scholle, S. H., Fontaine, P., & Whitebird, R. (2013). Medical home transformation: a gradual process and a continuum of attainment. The Annals of Family Medicine, 11(Suppl 1), S108–S114.CrossRefPubMedGoogle Scholar
  33. 33.
    Stevens, G. D., Shi, L., Vane, C., & Peters, A. L. (2014). Do experiences consistent with a medical-home model improve diabetes care measures reported by adult Medicaid patients? Diabetes Care, 37(9), 2565–2571.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Sugarman, J. R., Phillips, K. E., Wagner, E. H., Coleman, K., & Abrams, M. K. (2014). The safety net medical home initiative: transforming care for vulnerable populations. Medical Care, 52, S1–S10.CrossRefPubMedGoogle Scholar
  35. 35.
    The Commonwealth Fund. (2011). Evaluating medical home adoption in the safety net. Retrieved from http://www.commonwealthfund.org/publications/tools/2011/medical-home-adoption-in-the-safety-net.

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Kathryn E. Gunter
    • 1
  • Robert S. Nocon
    • 2
  • Yue Gao
    • 1
  • Lawrence P. Casalino
    • 3
  • Marshall H. Chin
    • 1
  1. 1.Section of General Internal Medicine, Department of MedicineUniversity of ChicagoChicagoUSA
  2. 2.Department of Public Health Sciences and Section of General Internal Medicine, Department of MedicineUniversity of ChicagoChicagoUSA
  3. 3.Department of Healthcare Policy and ResearchWeill Cornell Medical CollegeNew YorkUSA

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