Abstract
Background/Aims The patient-centered medical home (PCMH) is widely supported as a means to coordinate care in the primary care environment, but relatively little is known about how variation in implementation of a PCMH model influences the success and sustainability. Many survey instruments developed to date for assessing PCMH are aimed at the healthcare system design as a whole or at patient experience, but not at providers who may have varying attitudes and perspectives on the role of PCMH and unique insights into practical implementation issues. Our goal was to develop questionnaires aimed at primary care physicians (PCPs) and nurse case managers (CMs) to assess variation in perception and implementation of PCMH.
Methods This study was performed within Geisinger Health System, an integrated health system with a PCMH program first introduced in 2006. We reviewed care management, medical home, chronic illness and chronic care model literature, and existing tools such as Patients Assessment of Chronic Illness Care (PACIC). Based on 60-minute interviews with system leadership about program design, we developed pilot questions and completed 90-minute interviews with 3 highly-experienced nurse CMs to map global concepts of services and systems to individual staff member functions. Two structured questionnaires were developed for CMs and PCPs focusing on team interactions, linkages to outside resources, and tasks/responsibilities. Providers were asked to rate difficulty of various functions as well as their perceived impact on patient care.
Results We administered questionnaires during 60-minute semi-structured interviews with 47 clinical staff covering 23 medical home clinics. Case managers and physicians showed strong agreement on who bears responsibility for ensuring patient access (PCP), monitoring and linkages (CM) and education (Shared), but there was wide variation among clinics in perceived difficulty and impact of various tasks, particularly connecting patients with community resources and interacting with external nursing home facilities in different areas. Results of other questionnaire areas will be presented.
Conclusions Design characteristics, process measures and patient-level outcomes are all important in assessing benefits of a PCMH program, and this work contributes additional tools for measuring provider perspectives and variation in implementation across different PCMH sites.
