Article Figures & Data
Figures
- Figure 1.
A: Comparison of clinic-level Care by Design (CBD) scores versus patient-centered medical home (PCMH) self-estimated values. B: Comparison of provider-level CBD scores versus PCMH self-estimated values.
Tables
- Table 1. Comparison of Care by Design (CBD) and Patient-Centered Medical Home (PCMH) Metrics
CBD Elements (June 2009) Related 2008 PPC-PCMH 
ElementsAppropriate Access (AA) AA1 To acute care (ie, clinical need or patient request) by same-day appointment Same-day capacity AA2 To the provider for continuity of care Continuity of care AA4 Attention to call center messages (in-basket messages generated by call center to first contact to patient) Timely telephone advice during office hours AA5a Getting through to the office by phone for an appointment (dropped calls) AA5b Getting through to the office by phone for an appointment (TSF) Care Team (CT) CT1a Standardized documentation: X files Standardized narrative progress notes CT1b Standardized documentation: physical template Standardized narrative progress notes CT1c Standardized documentation: best practice alerts Recommended preventive screenings–by age Recommended risk screening–by age CT2 MAs in rotation for rooming patient CT4 Standardized stocking for exam rooms CT5 Use of technology supports real-time communication by all team members and with patient during the visit CT6 Patient never left alone, unless part of patient care CT7a Throughput: efficient check-in (patient waits ≤5 min from entering clinic to rooming) CT7b Throughput: efficient visit (patient waits ≤10 min during visit) CT9 Huddles and schedule reviews (most days = 3 to 4 days; most providers and MAs miss no more than 1 of each) CT10 Referrals made at time of appointment, or detailed instructions with phone number in after-visit summary CT11 Lab draws done in room CT12 Continuity of MA with patient throughout the visit CT13 MA engagement in the visit (required elements: uses x-files, addresses Best Practice Alerts, documents physical exam, places orders, gives After-Visit Summary to patient, makes follow up appointment) Complete standing orders for medication refills, tests, delivery of preventive care Condition management education to patients/families Planned Care (PC) PC1 Use of registries for chronic care and preventive services Previsit planning Clinician review or action Preventive care reminders Reminders for specific tests Reminders for follow-up visits (ie, chronic conditions) Care management support Previsit planning with clinician reminders PC2 Labs done prior to the visit Previsit planning with clinician reminders PC3 Documentation that after-visit summary was given to patient Condition management education to patients/families Individualized care plans in writing Provide written care plan to patient/family PC4 Motivational interviewing and goal setting for self-management Individualized treatment goals in writing Assess patient/family preference, readiness to change, and self-management abilities Patient/family self-care confidence PC5 Medication reconciliation Review medication lists with patients PC6 Emergency room/hospitalization records available at time of visit Review outside facility information to identify special outreach or at risk PC7 Procedure/consult notes available at time of visit (mammography, colonoscopy, endoscopy, cardiology) MA, medical assistant.
- Table 2. Scores on Care by Design and Self-Evaluated Patient-Centered Medical Home (PCMH) Metrics
Metric (Possible Range) Score (mean ± SD) Average Uptake (%) Faculty Practice/Residency Clinics* Other Clinics† All Clinics Faculty Practice/Residency Clinics Other Clinics PCMH (0–100) 63.93 ± 0.38 61.76 ± 1.09 62.5 ± 1.38 64 62 Care by Design (0–4) 1.71 ± 0.01 1.78 ± 0.25 1.76 ± 0.21 43 45 Appropriate access (0–4) 1.17 ± 0.11 1.32 ± 0.24 1.27 ± 0.21 29 33 Care teams (0–4) 2.21 ± 0.14 2.3 ± 0.27 2.27 ± 0.23 55 58 Planned care (0–4) 0.57 ± 0.38 0.43 ± 0.25 0.48 ± 0.3 14 11
