Article Figures & Data
Tables
Variable No. %* Location Metro 75 62.5 Non-metro 45 37.5 Ownership Health system 112 93.3 Health plan 4 3.3 Physicians 2 1.7 Medical services PC only 49 40.8 PC and some specialty 14 11.7 Multispecialty 55 45.8 Primary care MDs (n) 1–3 22 18.3 4–7 47 39.2 8–10 23 19.2 ≥11 24 20.0 NP/PAs (n) 0 8 6.7 1–3 67 55.8 ≥4 24 20.0 Clinics in medical group (n) 1 6 5.0 2–4 6 5.0 5–10 11 9.2 11–20 2 1.7 ≥21 90 75.0 Patient visits/week (n) <350 31 25.8 350–550 30 25.0 550–1000 28 23.3 >1000 29 24.2 Patient insurance Commercial 116 63.6 ± 22.6 Medicare 117 17.3 ± 10.9 Medicaid 117 14.8 ± 16.3 Uninsured 115 3.4 ± 6.0 Medical records Fully electronic 110 91.7 Paper + electronic 6 5.0 Paper only 0 0 ↵* Data are % except for Patient insurance, which are presented as mean ± standard deviation.
MD, medical doctor; NP, nurse practitioner; PA, physician assistant; PC, primary care.
- Table 2. Transformation Survey Item Scores among Patient-Centered Medical Home (PCMH) Leaders (n = 118)
Item Category Mean SD Providers were well accustomed to the EMR before PCMH. Information technology 4.68 43 Patient centeredness is a priority for us. Patients 4.55 0.54 Providing performance results to everyone is important. QI 4.42 0.53 We want PCMH because it fits our organization's mission. Culture 4.39 0.69 We have extensive top leadership support for PCMH. Leadership 4.31 0.56 We worked hard on patient centeredness. Patients 4.30 0.55 We regularly use QI methods on other projects. QI 4.26 0.59 We put much effort into making care teams functional. Organizational change 4.21 0.63 A physician leader to strongly lead change is important. Leadership 4.21 0.65 PCMH fits our desire to reduce unnecessary care. Finances 4.11 0.70 Our care teams worked hard on trust and communication. Organizational change 4.08 0.59 It was worth it to make the change to a PCMH. Culture 4.06 0.68 We had a specific team to implement PCMH changes. Organizational change 4.06 0.76 Our larger organization provided support and guidance. QI 4.02 0.69 It is not critical to have the right person as coordinator.* Organizational change 3.99 0.69 Creating care plans was a major part of our change. Organizational change 3.94 0.59 If patients have to pay, they won't enroll in the PCMH. Finances 3.91 0.70 We have the organizational resources we need. Leadership 3.86 0.59 We already were doing most of the PCMH activities. Culture 3.80 0.71 We could obtain needed resources for EMR barriers. Information technology 3.78 0.71 We used formal QI techniques to develop the PCMH. QI 3.68 0.76 We are expanding PCMH services to all our patients. Culture 3.64 0.83 Our PCMH strategy focused on practice system change. Organizational change 3.60 0.65 Patients report better experiences in our PCMH. Patients 3.56 0.57 We have a process for using patients as PCMH advisors. Patients 3.53 0.85 It was not difficult to modify our EMR for the PCMH.* Information technology 3.43 0.90 MDH leadership was helpful to our PCMH change. Organizational change 3.43 0.60 Patient partners are part of our change team. Patients 3.41 0.72 We got input on PCMH changes from patient partners. Patients 3.39 0.66 Changing our culture was important to become a PCMH. Culture 3.39 0.75 We protected clinician income during the change. Finances 3.39 0.88 The PCMH learning collaborative was helpful. QI 3.32 0.59 PCMH reimbursement is a problem. Finances 3.28 0.72 We still have a long way to go to become a PCMH. Organizational change 3.23 0.69 The MDH PCMH certification process wasn't burdensome. Organizational change 3.17 0.74 Care plan development was not difficult.* Organizational change 3.13 0.79 Buy-in from everyone for the PCMH was a major challenge. Culture 3.11 0.83 Public performance reporting wasn't an incentive for us.* QI 3.10 0.75 Staff job satisfaction has increased with PCMH changes. Culture 3.00 0.56 Physician satisfaction has increased with PCMH changes. Culture 2.89 0.67 Few workflow changes were needed.* Organizational change 2.85 0.77 Financial resources were adequate for added PCMH staff. Finances 2.59 0.77 Care coordination fee income was a motivator for PCMH. Finances 2.50 0.76 A care coordination job description isn't important.* Organizational change 1.87 0.67 ↵* Item is negatively worded and reverse-coded.
EMR, electronic medical record; MDH, Minnesota Department of Health; SD, standard deviation; QI, quality improvement.
- Table 3. Transformation Survey Items Correlated with System Change Score Over 3 Years (r ≥ 0.20)
Transformation Category and Items Mean Spearman r P Value Organizational change* Our care teams worked hard on trust and communication. 4.08 0.32 <.001 We had a specific team to implement PCMH changes. 4.06 0.36 <.001 Creating care plans was a major part of our change. 3.94 0.33 <.001 Our PCMH strategy focused on practice system change. 3.60 0.25 .01 MDH leadership was helpful to our PCMH change. 3.43 0.36 <.001 A care coordination job description isn't important. 1.87 −0.40 <.001 Patients† Patients report better experiences in our PCMH. 3.56 0.29 .003 We have a process for using patients as PCMH advisors. 3.53 0.34 <.001 We got input on PCMH changes from patient partners. 3.39 0.28 .004 Patient partners are part of our change team. 3.41 0.34 <.001 Culture‡ It was worth it to make the change to medical home. 4.06 0.34 <.001 We are expanding PCMH services to all our patients. 3.64 0.28 .003 Staff job satisfaction has increased with PCMH changes. 3.00 0.26 .01 Physician satisfaction has increased with PCMH changes. 2.89 0.28 .004 Finances§ PCMH fit our desire to reduce unnecessary care. 4.11 0.30 .002 We protected clinician income during the change. 3.39 0.26 .008 Quality improvement‖ We used formal quality improvement techniques to develop the PCMH. 3.68 0.46 <.001 MDH, Minnesota Department of Health; PCMH, patient-centered medical home.
Leadership (3 items) and Information Technology (3 items) items were not related to systems change scores at r ≥ 0.20.
↵* r ≥ 0.20 for 6 of 12 items.
↵† r ≥ 0.20 for 4 of 5 items.
↵‡ r ≥ 0.20 for 4 of 8 items.
↵§ r ≥ 0.20 for 2 of 6 items.
↵‖ r ≥ 0.20 for 1 of 6 items.
