Medical Home Characteristics and Quality of Diabetes Care in Safety Net Clinics
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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.
KeywordsPatient-centered medical home Quality Primary care Safety net Diabetes
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.
- 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.
- 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
- 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.
- 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
- 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.
- 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.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.
- 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
- 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
- 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.