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Patient Experience of Chronic Illness Care and Medical Home Transformation in Safety Net Clinics
Author(s) -
Tung Elizabeth L.,
Gao Yue,
Peek Monica E.,
Nocon Robert S.,
Gunter Kathryn E.,
Lee Sang Mee,
Chin Marshall H.
Publication year - 2018
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12608
Subject(s) - medicine , medical home , confidence interval , intervention (counseling) , safety net , patient safety , chronic care , cross sectional study , healthcare delivery , physical therapy , primary care , health care , family medicine , nursing , environmental health , pathology , economics , economic growth
Objective To examine the relationship between medical home transformation and patient experience of chronic illness care. Study Setting Thirteen safety net clinics located in five states enrolled in the Safety Net Medical Home Initiative. Study Design Repeated cross‐sectional surveys of randomly selected adult patients were completed at baseline ( n = 303) and postintervention ( n = 271). Data Collection Methods Questions from the Patient Assessment of Chronic Illness Care ( PACIC ) (100‐point scale) were used to capture patient experience of chronic illness care. Generalized estimating equation methods were used to (i) estimate how differential improvement in patient‐centered medical home ( PCMH ) capability affected differences in modified PACIC scores between baseline and postintervention, and (ii) to examine cross‐sectional associations between PCMH capability and modified PACIC scores for patients at completion of the intervention. Principal Findings In adjusted analyses, high PCMH improvement (above median) was only marginally associated with a larger increase in total modified PACIC score (adjusted β = 7.7, 95 percent confidence interval [ CI ]: −1.1 to 16.5). At completion of the intervention, a 10‐point higher PCMH capability score was associated with an 8.9‐point higher total modified PACIC score (95 percent CI : 3.1–14.7) and higher scores in four of five subdomains (patient activation, delivery system design, contextual care, and follow‐up/coordination). Conclusions We report that sustained, 5‐year medical home transformation may be associated with modest improvement in patient experience of chronic illness care for vulnerable populations in safety net clinics.