Impact of the patient-centered medical home on veterans' experience of care

A core tenet of the patient-centered medical home is improving patient experiences of care, but evidence is limited on the impact of medical home adoption on patient experiences of care. We conducted a repeated cross-sectional, patient-level analysis in 1 region of the Veterans Health Administration (VHA), which includes 56 primary care sites. Our primary outcomes include 5 domains of patient care experience from the Survey of Healthcare Experiences of Patients (SHEP). We used a linear probability model to test whether changes in medical home implementation are associated with changes in patient experience of care. During the study period, 30,849 SHEP respondents received care. We observed significant increase in medical home implementation: a 10-fold increase in percentage of primary care providers who were part of a medical home, a 7-fold increase in 8 out of 9 structural measures of the medical home, and an increase in overall quality of medical home implementation. Yet, we found no association between medical home adoption and 5 domains of patient experience of care. For example, patients assigned to a medical home provider had a 0.51 percentage point (95% CI, -1.8 to 2.8) higher response in how well they communicate with their provider compared with patients not assigned to a medical provider and with patients in the pre-medical home period. Despite wide implementation of the medical home, we did not see an improvement in patient experiences of care in the VHA. As we focus on primary care transformation, we need to find ways to incorporate the patient's voice and input into these transitions.