Abstract
Background: Many have called for the adoption of the patient-centered medical home (PCMH) model with the expectation that such a model will alleviate ills of the American health care system. Little has been published that evaluates implementations of the PCMH as a comprehensive primary care practice redesign intervention in an actual care setting. We present reported patient experience and clinician burnout following the adoption of this model.
Methods: To assess patient experience, a total of 6,187 adult patients from the PCMH clinic and two control clinics were surveyed prior to the PCMH deployment and again twelve months following its adoption. Patient experience was measured using the Ambulatory Care Experiences Survey – Short Form (ACES) and two subscales from the Patient Assessment of Chronic Illness Care (PACIC). To assess clinician experience, we surveyed all clinicians (n=132) at the PCMH clinic and two control clinics at baseline and twelve months. Clinician experience was measured using the three Maslach Burnout Inventory (MBI) sub scores of emotional exhaustion, depersonalization, and lack of personal accomplishment.
Results: Patient survey response rate was 55% at baseline and 80% at 12-month follow-up. Twelve months after the PCMH deployment, 4 of 7 patient experience subscales improved at the PCMH clinic (quality of doctor-patient interactions, coordination of care, patient activation, and goal setting). Only 2 of 7 improved at the control clinics. After adjusting for baseline patient experience, age, education, and self reported health status at baseline in the linear regression, patients at the PCMH clinic had significantly improved patient experience in 6 of 7 subscales compared to patients at the control clinics. Clinician survey response rate was 76% at baseline and 83% at 12-month follow-up. At baseline, burnout in all three sub scores was not significantly different between the PCMH clinic and control clinics. At twelve months, clinicians at the PCMH clinic reported significantly lower burnout compared to the control clinics on the emotional exhaustion and lack of personal accomplishment subscales and trended lower on the depersonalization subscale (P=0.06).
Conclusions: Twelve months following adoption, patients at the PCMH clinic reported superior patient experience compared to control clinics. Clinicians at the PCMH clinic also reported significantly less burnout compared to their control counterparts.
