Effects of patient-centered medical home attributes on patients' perceptions of quality in federally supported health centers

Abstract

Purpose: We sought to assess patients' ratings of patient-centered medical home (PCMH) attributes and overall quality of care within federally supported health centers.

Methods: Data were collected through the 2009 Health Center Patient Survey (n = 4,562), which consisted of in-person interviews and included a nationally representative sample of patients seen in health centers. Quality measures included patients' perceptions of overall quality of services, perceptions of quality of clinician advice/treatment, and likelihood of referring friends and relatives to the health center. PCMH attributes included (1) access to care getting to health center, (2) access to care during visit, (3) patient-centered communication with health care clinicians, (4) patient-centered communication with support staff, (5) self-management support for chronic conditions, (6) self-management support for behavioral risks, and (7) comprehensive preventive care. Bivariate analysis and logistic regressions were used to examine associations between patients' perceptions of PCMH attributes and patient-reported quality of care.

Results: Eighty-four percent of patients reported excellent/very good overall quality of services, 81% reported excellent/very good quality of clinician care, and 84% were very likely to refer friends and relatives. Higher patient ratings on the access to care and patient-centered communication attributes were associated with higher odds of patient-reported high quality of care on the 3 outcome measures.

Conclusions: More than 80% of patients perceived high quality of care in health centers. PCMH attributes related to access to care and communication were associated with greater likelihood of patients reporting high-quality care.

Keywords: health care quality assessment; patient-centered care; primary care; vulnerable populations.

Figure 1

Patient sample selection process. ^a Patients were excluded if they did not have at least 1 previous visit to the health center in the past year, were unaccompanied minors, or if the quota for special populations had already been met (ie, homeless, farm worker, public housing resident).