An assessment of patient-based and practice infrastructure-based measures of the patient-centered medical home: do we need to ask the patient?

Abstract

Objective: To examine the importance of patient-based measures and practice infrastructure measures of the patient-centered medical home (PCMH).

Data sources: A total of 3,671 patient surveys of 202 physicians completing the American Board of Internal Medicine (ABIM) 2006 Comprehensive Care Practice Improvement Module and 14,457 patient chart reviews from 592 physicians completing ABIM's 2007 Diabetes and Hypertension Practice Improvement Module.

Methodology: We estimated the association of patient-centered care and practice infrastructure measures with patient rating of physician quality. We then estimated the association of practice infrastructure and patient rating of care quality with blood pressure (BP) control.

Results: Patient-centered care measures dominated practice infrastructure as predictors of patient rating of physician quality. Having all patient-centered care measures in place versus none was associated with an absolute 75.2 percent increase in the likelihood of receiving a top rating. Both patient rating of care quality and practice infrastructure predicted BP control. Receiving a rating of excellent on care quality from all patients was associated with an absolute 4.2 percent improvement in BP control. For reaching the maximum practice-infrastructure score, this figure was 4.5 percent.

Conclusion: Assessment of physician practices for PCMH qualification should consider both patient based patient-centered care measures and practice infrastructure measures.