Transforming primary care in the New Orleans safety-net: the patient experience

Abstract

Background: The patient-centered medical home (PCMH) is a key service delivery innovation in health reform. However, there are growing questions about whether the changes in clinics promoted by the PCMH model lead to improvements in the patient experience.

Objective: To test the hypothesis that PCMH improvements in safety-net primary care clinics are associated with a more positive patient experience.

Research design: Multilevel cross-sectional analysis of patients nested within the primary care clinics that serve them.

Subjects: Primary care clinic leaders and patients throughout the City of New Orleans health care safety-net.

Measures: Dependent variables included patient ratings of accessibility, coordination, and confidence in the quality/safety of care. The key independent variable was a score measuring PCMH structural and process improvements at the clinic level.

Results: Approximately two thirds of patients in New Orleans gave positive ratings to their clinics on access and quality/safety, but only one third did for care coordination. In all but the largest clinics, patient experiences of care coordination were positively associated with the clinic's use of PCMH structural and process changes. Results for patient ratings of access and quality/safety were mixed.

Conclusions: Among primary care clinics in the New Orleans safety-net, use of more PCMH improvements at the clinic level led to more positive patient rating of care coordination, but not of accessibility or confidence in quality/safety. Ongoing efforts to pilot, demonstrate, implement, and evaluate the PCMH should consider how the impact of medical practice transformation could vary across different aspects of the patient experience.