Using fuzzy set qualitative comparative analysis (fs/QCA) to explore the relationship between medical "homeness" and quality

Abstract

Objective: Determine, using fuzzy set qualitative comparative analysis (fs/QCA), the relationship between patient-centered medical home (PCMH) systems and quality in 21 NCQA recognized medical homes.

Data sources/study setting: Primary data collected in 2009, including measures of optimal diabetes care (ODC), preventive services up-to-date (PSUTD), patient experience (PEX), survey data assessing PCMH capabilities (PPC-RS), and other clinic characteristics.

Study design: Cross-sectional study identifying associations between PPC-RS domains, demographic, socioeconomic, and co-morbidity measures, and quality outcomes.

Data collection/extraction methods: PPC-RS scores were obtained by surveying clinic leaders. PSUTD and ODC scores were obtained from provider performance data. PEX data were obtained from patient surveys. Demographic, socioeconomic, and co-morbidity data were obtained from EMR and census data.

Principal findings: fs/QCA identified associations between all three outcomes and PCMH capabilities: ODC and team-based care; PSUTD and preventive services systems; and all three outcomes and provider performance reporting systems. Previous statistical analysis of this data had failed to identify these relationships.

Conclusions: fs/QCA identified important associations that were overlooked using conventional statistics in a small-N health services data set. PCMH capabilities are associated with quality outcomes.

Figure 1

Graphical Representation of Fuzzy Set Relationships. Actual output from fs/QCA graph capability demonstrating that higher socioeconomic status is a necessary but not sufficient condition for achieving better optimal diabetes care. In other words, ODC is a fuzzy subset of ∼LOWSES (not low socioeconomic status). The consistency of the set relationship is 0.96; and the coverage is 0.62