Article Figures & Data
Tables
- Table 1.
Bivariate Associations of Physician and Practice Characteristics with Advance Care Planning*
Variable Total Respondents, n (%) Routinely Engage About ACP, n (%) Do Not Routinely Engage About ACP, n (%) P value Practice is a APCP/PCMH (binary variable) 338 (34.6) 169 (36.9) 169 (32.6) .18 Age 45+ 714 (73.6) 349 (76.9) 365 (70.7) .001 Male 589 (60.6) 308 (67.7) 281 (54.4) .001 Consider work high stress 433 (44.8) 217 (47.9) 216 (42.0) .07 Practice location .001 City 379 (39.2) 186 (41.1) 193 (37.6) Suburb 304 (31.5) 119 (26.3) 185 (36.1) Small town 175 (18.1) 91 (20.1) 84 (16.4) Rural 108 (11.2) 57 (12.6) 51 (9.9) Practice belongs to an ACO 347 (36.1) 184 (40.6) 163 (32.0) .01 Physician payment Clinical targets 370 (38.2) 200 (44.2) 170 (32.9) .001 CMS incentives 441 (45.6) 237 (52.2) 204 (39.7) .001 Fee for service 604 (68.5) 300 (73.2) 304 (64.4) .01 Capitation 210 (25.8) 119 (31.4) 91 (20.9) .001 Salary 461 (52.7) 200 (49.0) 261 (56.0) .05 Practice often sees patients with: Multiple chronic conditions 812 (84.4) 443 (98.0) 369 (72.4) .001 Palliative care needs 216 (22.5) 157 (35.0) 59 (11.6) .001 Practice does home visits 333 (35.2) 217 (48.8) 116 (23.2) .001 ↵* N = 1001. All these analyses were done using χ2 tests, using data that had not yet undergone imputation. Therefore, each row has slightly different Ns associated due to different levels of missing data for each variable. APCP/PCMH, Advanced Primary Care Practice/Patient Centered Medical Home; ACO, Accountable Care Organization; CMS, Centers for Medicare & Medicaid services..
- Table 2.
Multivariable Regression Predicting Physicians Routinely Engaging Older and Sicker Patients in Advance Care Planning, Using Binary PCMH Variable*
Variable Odds Ratio 95% Confidence Interval P value Practice is APCP/PCMH (binary variable) 1.00 (0.72–1.49) .99 Age 45+ 1.22 (0.87–1.72) .25 Male 1.40 (1.03–1.90) .03 Consider work high stress 0.99 (0.74–1.32) .94 Practice location City reference Suburb 0.66 (0.46–0.94) .02 Small town 0.98 (0.65–1.48) .94 Rural 0.86 (0.53–1.40) .55 Practice belongs to an ACO 1.14 (0.82–1.57) .43 Physician payment Clinical targets 1.42 (1.04–1.94) .03 CMS incentives 1.18 (0.87–1.60) .28 Fee for service 1.14 (0.73–1.78) .57 Capitation 1.48 (1.03–2.11) .03 Salary 0.92 (0.61–1.37) .67 Practice often sees patients with: Multiple chronic conditions 11.53 (5.67–23.42) <.001 Palliative care needs 2.36 (1.65–3.36) <.001 Practice does home visits 2.12 (1.56–2.88) <.001 APCP, advanced primary care; PCMH, patient centered medical home; ACO, accountable care organization.
↵* N = 977. Values imputed when absent.
Bolded items and values are statistically significant.
Unadjusted Logistic Regression Adjusted Logistic Regression OR (95% CI) P value OR (95% CI) P value APCP index 1.11 (1.09, 1.13) <.001 1.09 (1.06, 1.12) <.001 APCP, advanced primary care; PCMH, patient centered medical home; ACO, accountable care organization; OR, odds ratio; CI, confidence interval.
- Table 4.
Multivariable Regression of Advance Care Planning Conversations, Including the APCP Index*
Variable Odds Ratio 95% Confidence Interval P value APCP index 1.07 (1.05–1.09) .00 Age 45+ 1.26 (0.89–1.79) .20 Male 1.30 (0.95–1.78) .10 Considering work high stress 1.06 (0.79–1.42) .70 Practice location City reference Suburb 0.65 (0.45–0.93) .02 Small town 0.94 (0.62–1.43) .78 Rural 0.89 (0.54–1.46) .63 Practice belongs to an ACO 0.96 (0.69–1.33) .81 Physician payment Clinical targets 1.15 (0.83–1.59) .40 CMS incentives 0.94 (0.69–1.29) .71 Fee for service 1.16 (0.73–1.82) .53 Capitation 1.48 (1.03–2.13) .04 Salaried 0.83 (0.55–1.24) .36 Practice often sees patients with: Multiple chronic conditions 9.95 (4.87–20.34) .00 Palliative care needs 2.03 (1.41–2.93) .00 Practice does home visits 2.01 (1.47–2.75) .00 APCP, advanced primary care. ACO, accountable care organization.
↵* N = 977. Values imputed when absent.
Bolded items and values are statistically significant.
Items and Statistics for Index of APCP-PCMH
Q# Question Q9. Do you/other personnel that work in the practice provide care in any of the following: Q# Question Q11. How prepared is your practice to manage care for the following patients: Q16. When your pt goes to ED or admitted to hospital how often do you receive: Q# Question Q20. If any of your pts receive home health services how often do: Q28b. Does your practice offer patients the option to: Q29. Can your practice generate information about your patients using computerized processes: Q30. Are the following routinely performed in your practice using computer: Q31. Does the place where you practice routinely receive and review data re the following: Index Item-Total Statistics
Question in 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians in 10 Nations used to create the index of APCP/PCMH Scale Mean if Item Deleted Scale Variance if Item Deleted Corrected Item-Total Correlation Cronbach's Alpha if Item Deleted q3 - Your rating of changes in quality of medical care patients receive compared to 3 years previously? 23.41 58.059 0.230 0.879 q8 - Does your practice have an arrangement where patients can see a Dr or nurse if needed when the practice is closed, without going to hospital or ED? 23.27 57.952 0.212 0.879 q9 - Do you/other personnel that work in the practice provide care in any of the following: q9b - Coordinate f/u care with hospitals? 22.80 58.164 0.284 0.878 q9d - Coordinate care with social services or other community providers? 22.77 58.627 0.225 0.878 q11. - How prepared is your practice to manage care for the following patients: q11a - Chronic illness? 22.91 57.411 0.333 0.877 q11b - Mental health problems? 23.51 58.352 0.229 0.878 q11c - Substance use issues? 23.51 58.242 0.255 0.878 q11d - In need of palliative care? 23.31 56.837 0.374 0.876 q11e - In need of Long Term Care? 23.25 56.555 0.401 0.876 q11f - With community needs? 23.37 57.149 0.349 0.877 q11g - Needing language translation? 23.32 57.705 0.254 0.878 q11h - With dementia? 23.29 56.876 0.363 0.876 q12 - Does your practice use personnel to monitor and manage care for patients with chronic conditions that need regular follow up care? 23.01 56.487 0.428 0.875 q13 - Are pts with chronic conditions given written instructions about how to manage their own care at home? 22.77 58.177 0.324 0.877 q14 - For patients with chronic conditions are their self management goals recorded in their med record?? 22.87 57.870 0.285 0.878 q15a - A report back with all relevant health info? 22.91 57.524 0.316 0.877 q15b - Info about changes specialist has made to med or care plan? 22.95 57.232 0.344 0.877 q15c - Info that is timely and available when needed? 23.03 57.363 0.299 0.878 q 16. - When your patient goes to the ED or is admitted to the hospital how often do you receive: q16a - Notification seen in ED or admitted to hospital? 22.95 57.084 0.364 0.876 q16b - Notification being dc'd from hospital? 22.99 56.798 0.389 0.876 q17 - After hospital dc how long does it take for you to get info needed to manage the patient? 22.92 57.705 0.286 0.878 q20. - If any of your patients receive home health services how often do: q20a - You or practice personnel communicate with patient's home care provider? 23.22 56.955 0.342 0.877 q20b - Are you advised of a relevant change in patient's condition? 23.12 57.042 0.330 0.877 q21 - How easy or difficult is it to coordinate patient care with social services or other community providers? 23.34 57.393 0.302 0.878 q28b. - Does your practice offer patients the option to: q28ba - Email the practice? 23.08 57.102 0.325 0.877 q28bb - View, download, etc, information from the medical record? 23.05 56.424 0.425 0.875 q29 - Can your practice generate information about your patients using computerized processes: q29a - List of patients by diagnosis? 22.89 56.987 0.419 0.876 q29b - List by if patient is overdue for preventive care? 23.01 55.983 0.500 0.874 q29d - List of medications taken by individual patient? 22.94 56.580 0.448 0.875 q29e - List of lab results for individual patient? 23.04 56.409 0.431 0.875 q29f - Clinical summary for each visit to give to the patient? 22.89 56.982 0.415 0.876 Q30.- Are the following routinely performed in your practice using computer: q30a - Patient sent reminder notices about preventive or follow up care? 23.26 56.453 0.418 0.875 q30b - All lab tests followed until results reach clinicians? 23.05 56.503 0.415 0.875 q30c - You receive prompt to provide patient with test results? 23.16 56.428 0.412 0.876 q30d - You receive reminder about guideline based intervention/screening? 23.20 56.067 0.462 0.875 q31. - Does the place where you practice routinely receive and review data about the following: q31a - Clinical outcomes? 23.15 55.875 0.488 0.874 q 31b. - Surveys of patient satisfaction? 23.03 56.270 0.453 0.875 q31c. - Patient hospital or emergency department use? 23.10 56.262 0.439 0.875 q31d. - % of patients receiving recommended care? 23.10 55.882 0.492 0.874 q32. Are any of your own clinical performance reviewed against targets at least annually? 22.92 56.825 0.419 0.876 q33. Do you receive info on how the clinical performance of your practice compares to other practices? 22.99 57.036 0.355 0.877
