The patient-centered medical home and patient experience.

The U.S. health care system exhibits substantial gaps between current practices and optimal care. These gaps have been associated with preventable deaths, morbidity, cost, and consumer dissatisfaction (Institute of Medicine, Committee on Quality of Health Care in America 2001). To address these problems, groups such as the American College of Physicians, the American Academy of Family Physicians, and others have promoted the redesign of organizational infrastructure and clinical care processes in accordance with the functional domains of the patient-centered medical home (PCMH). PCMH is a “team-based model of care led by a personal physician who provides continuous and coordinated care throughout a patient's lifetime in order to maximize health outcomes” (American College of Physicians 2010). The seven principles of the PCMH include a personal physician, physician-directed medical practice, whole-person orientation, coordinated and integrated care, quality measurement and improvement, enhanced access to care, and payment reforms (Patient-Centered Care Collaborative 2007). Much of the existing research on the PCMH has focused on the relationship between medical homes1 and health care–related outcomes. Several studies, for example, suggest that medical homes are associated with increased utilization of preventive services (Gill et al. 2005; Ferrante et al. 2010; Jaen et al. 2010) and decreased hospitalizations and emergency room visits (Palfrey et al. 2004; Gill et al. 2005; Martin et al. 2007; Cooley et al. 2009; Rankin et al. 2009; Roby et al. 2010). Others have also identified improvements in quality (Rankin et al. 2009; Reid et al. 2009, 2010; Jaen et al. 2010 ) and reduced clinician burnout (Reid et al. 2009, 2010). However, the relationship between PCMH and patients' care experience has received less research attention, despite the fact that the PCMH model places both practical and philosophical emphasis on patient-centered care. The limited existing research in this area has produced mixed findings. While some studies have found an association between the PCMH and improved patient experience, others have found that patients have had negative or no significant changes in experiences after PCMH implementation (DeVoe et al. 2008; Reid et al. 2009, 2010; Jaen et al. 2010). This study examines the relationship between the degree to which physician practices use PCMH processes and patients' perceptions of the care experience in those practices. Previous related studies have been limited to single-source survey data (such as the Medical Expenditure Panel Survey), single health systems, or practices that had self-selected into a PCMH demonstration project. Our study attempts to address some of these limitations by using a large novel dataset that links responses from a national survey of individuals with chronic disease to two independently administered national surveys of physician practices. Furthermore, this dataset allows us to analyze the association between PCMH processes and patient experience across a large number of diverse practices. A recent paper issued by the Agency for Healthcare Research and Quality ([AHRQ] AHRQ 2011) suggested that, instead of evaluating PCMH implementation within a small set of practices with a large number of patients at each practice, researchers should instead use data from across multiple practices with fewer patients in each practice (AHRQ 2011). Our dataset is uniquely structured to do that. Using this dataset, we address the following research question: Do patients who receive care in physician practices that use more PCMH processes report better care experiences, conditional on other patient and practice characteristics?