Association of Patient-Centered Medical Home designation and quality indicators within HRSA-funded community health center delivery sites
Abstract Background Patient-Centered Medical Home (PCMH) adoption is an important strategy to help improve primary care quality within Health Resources and Service Administration (HRSA) community health centers (CHC), but evidence of its effect thus far remains mixed. A limitation of previous evalua...
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| Format: | Article |
| Language: | English |
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BMC
2020-10-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-020-05826-x |
| _version_ | 1811292981852897280 |
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| author | Nathaniel Bell Rebecca Wilkerson Kathy Mayfield-Smith Ana Lòpez-De Fede |
| author_facet | Nathaniel Bell Rebecca Wilkerson Kathy Mayfield-Smith Ana Lòpez-De Fede |
| author_sort | Nathaniel Bell |
| collection | DOAJ |
| description | Abstract Background Patient-Centered Medical Home (PCMH) adoption is an important strategy to help improve primary care quality within Health Resources and Service Administration (HRSA) community health centers (CHC), but evidence of its effect thus far remains mixed. A limitation of previous evaluations has been the inability to account for the proportion of CHC delivery sites that are designated medical homes. Methods Retrospective cross-sectional study using HRSA Uniform Data System (UDS) and certification files from the National Committee for Quality Assurance (NCQA) and the Joint Commission (JC). Datasets were linked through geocoding and an approximate string-matching algorithm. Predicted probability scores were regressed onto 11 clinical performance measures using 10% increments in site-level designation using beta logistic regression. Results The geocoding and approximate string-matching algorithm identified 2615 of the 6851 (41.8%) delivery sites included in the analyses as having been designated through the NCQA and/or JC. In total, 74.7% (n = 777) of the 1039 CHCs that met the inclusion criteria for the analysis managed at least one NCQA- and/or JC-designated site. A proportional increase in site-level designation showed a positive association with adherence scores for the majority of all indicators, but primarily among CHCs that designated at least 50% of its delivery sites. Once this threshold was achieved, there was a stepwise percentage point increase in adherence scores, ranging from 1.9 to 11.8% improvement, depending on the measure. Conclusion Geocoding and approximate string-matching techniques offer a more reliable and nuanced approach for monitoring the association between site-level PCMH designation and clinical performance within HRSA’s CHC delivery sites. Our findings suggest that transformation does in fact matter, but that it may not appear until half of the delivery sites become designated. There also appears to be a continued stepwise increase in adherence scores once this threshold is achieved. |
| first_indexed | 2024-04-13T04:54:35Z |
| format | Article |
| id | doaj.art-9ce9f23230a74e74b411c05ccb21f790 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-13T04:54:35Z |
| publishDate | 2020-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-9ce9f23230a74e74b411c05ccb21f7902022-12-22T03:01:34ZengBMCBMC Health Services Research1472-69632020-10-0120111110.1186/s12913-020-05826-xAssociation of Patient-Centered Medical Home designation and quality indicators within HRSA-funded community health center delivery sitesNathaniel Bell0Rebecca Wilkerson1Kathy Mayfield-Smith2Ana Lòpez-De Fede3College of Nursing, University of South CarolinaDivision of Integrated Health and Policy Research, Institute for Families in Society, University of South CarolinaDivision of Integrated Health and Policy Research, Institute for Families in Society, University of South CarolinaDivision of Integrated Health and Policy Research, Institute for Families in Society, University of South CarolinaAbstract Background Patient-Centered Medical Home (PCMH) adoption is an important strategy to help improve primary care quality within Health Resources and Service Administration (HRSA) community health centers (CHC), but evidence of its effect thus far remains mixed. A limitation of previous evaluations has been the inability to account for the proportion of CHC delivery sites that are designated medical homes. Methods Retrospective cross-sectional study using HRSA Uniform Data System (UDS) and certification files from the National Committee for Quality Assurance (NCQA) and the Joint Commission (JC). Datasets were linked through geocoding and an approximate string-matching algorithm. Predicted probability scores were regressed onto 11 clinical performance measures using 10% increments in site-level designation using beta logistic regression. Results The geocoding and approximate string-matching algorithm identified 2615 of the 6851 (41.8%) delivery sites included in the analyses as having been designated through the NCQA and/or JC. In total, 74.7% (n = 777) of the 1039 CHCs that met the inclusion criteria for the analysis managed at least one NCQA- and/or JC-designated site. A proportional increase in site-level designation showed a positive association with adherence scores for the majority of all indicators, but primarily among CHCs that designated at least 50% of its delivery sites. Once this threshold was achieved, there was a stepwise percentage point increase in adherence scores, ranging from 1.9 to 11.8% improvement, depending on the measure. Conclusion Geocoding and approximate string-matching techniques offer a more reliable and nuanced approach for monitoring the association between site-level PCMH designation and clinical performance within HRSA’s CHC delivery sites. Our findings suggest that transformation does in fact matter, but that it may not appear until half of the delivery sites become designated. There also appears to be a continued stepwise increase in adherence scores once this threshold is achieved.http://link.springer.com/article/10.1186/s12913-020-05826-xHealth Resources and Services AdministrationCommunity Health centersMedical homeGeographic mapping |
| spellingShingle | Nathaniel Bell Rebecca Wilkerson Kathy Mayfield-Smith Ana Lòpez-De Fede Association of Patient-Centered Medical Home designation and quality indicators within HRSA-funded community health center delivery sites BMC Health Services Research Health Resources and Services Administration Community Health centers Medical home Geographic mapping |
| title | Association of Patient-Centered Medical Home designation and quality indicators within HRSA-funded community health center delivery sites |
| title_full | Association of Patient-Centered Medical Home designation and quality indicators within HRSA-funded community health center delivery sites |
| title_fullStr | Association of Patient-Centered Medical Home designation and quality indicators within HRSA-funded community health center delivery sites |
| title_full_unstemmed | Association of Patient-Centered Medical Home designation and quality indicators within HRSA-funded community health center delivery sites |
| title_short | Association of Patient-Centered Medical Home designation and quality indicators within HRSA-funded community health center delivery sites |
| title_sort | association of patient centered medical home designation and quality indicators within hrsa funded community health center delivery sites |
| topic | Health Resources and Services Administration Community Health centers Medical home Geographic mapping |
| url | http://link.springer.com/article/10.1186/s12913-020-05826-x |
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