Development of a Safety Net Medical Home Scale for Clinics
Background Existing tools to measure patient-centered medical home (PCMH) adoption are not designed for research evaluation in safety-net clinics. Objective Develop a scale to measure PCMH adoption in safety-net clinics. Research Design Cross-sectional survey. Subjects Sixty-five clinics in five sta...
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| Veröffentlicht in: | Journal of general internal medicine : JGIM 2011-12, Vol.26 (12), p.1418-1425 |
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| creator | Birnberg, Jonathan M. Drum, Melinda L. Huang, Elbert S. Casalino, Lawrence P. Lewis, Sarah E. Vable, Anusha M. Tang, Hui Quinn, Michael T. Burnet, Deborah L. Summerfelt, Thomas Chin, Marshall H. |
| description | Background
Existing tools to measure patient-centered medical home (PCMH) adoption are not designed for research evaluation in safety-net clinics.
Objective
Develop a scale to measure PCMH adoption in safety-net clinics.
Research Design
Cross-sectional survey.
Subjects
Sixty-five clinics in five states.
Main Measures
Fifty-two-item Safety Net Medical Home Scale (SNMHS). The total score ranges from 0 (worst) to 100 (best) and is an average of multiple subscales (0–100): Access and Communication, Patient Tracking and Registry, Care Management, Test and Referral Tracking, Quality Improvement, and External Coordination. The scale was tested for internal consistency reliability and tested for convergent validity using The Assessment of Chronic Illness Care (ACIC) and the Patient-Centered Medical Home Assessment (PCMH-A). The scale was applied to centers in the sample. In addition, linear regression models were used to measure the association between clinic characteristics and medical home adoption.
Results
The SNMHS had high internal consistency reliability (Cronbach’s alpha = 0.84). The SNMHS score correlated moderately with the ACIC score (r = 0.64, p |
| doi_str_mv | 10.1007/s11606-011-1767-9 |
| format | Article |
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Existing tools to measure patient-centered medical home (PCMH) adoption are not designed for research evaluation in safety-net clinics.
Objective
Develop a scale to measure PCMH adoption in safety-net clinics.
Research Design
Cross-sectional survey.
Subjects
Sixty-five clinics in five states.
Main Measures
Fifty-two-item Safety Net Medical Home Scale (SNMHS). The total score ranges from 0 (worst) to 100 (best) and is an average of multiple subscales (0–100): Access and Communication, Patient Tracking and Registry, Care Management, Test and Referral Tracking, Quality Improvement, and External Coordination. The scale was tested for internal consistency reliability and tested for convergent validity using The Assessment of Chronic Illness Care (ACIC) and the Patient-Centered Medical Home Assessment (PCMH-A). The scale was applied to centers in the sample. In addition, linear regression models were used to measure the association between clinic characteristics and medical home adoption.
Results
The SNMHS had high internal consistency reliability (Cronbach’s alpha = 0.84). The SNMHS score correlated moderately with the ACIC score (r = 0.64, p < 0.0001) and the PCMH-A (r = 0.56, p < 0.001). The mean SNMHS score was 61 ± SD 13. Among the subscales, External Coordination (66 ± 16) and Access and Communication (65 ± 14) had the highest mean scores, while Quality Improvement (55 ± 17) and Care Management (55 ± 16) had lower mean scores. Clinic characteristics positively associated with total SNMHS score were having more providers (β 15.8 95% CI 8.1–23.4 >8 provider FTEs compared to <4 FTEs) and participation in financial incentive programs (β 8.4 95% 1.6–15.3).
Conclusion
The SNMHS demonstrated reliability and convergent validity for measuring PCMH adoption in safety-net clinics. Some clinics have significant PCMH adoption. However, room for improvement exists in most domains, especially for clinics with fewer providers.</description><identifier>ISSN: 0884-8734</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1007/s11606-011-1767-9</identifier><identifier>PMID: 21837377</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Ambulatory Care Facilities - standards ; Ambulatory Care Facilities - trends ; Biological and medical sciences ; Clinics ; Community health care ; Cross-Sectional Studies - methods ; General aspects ; Humans ; Internal Medicine ; Medical sciences ; Medicine ; Medicine & Public Health ; Miscellaneous ; Original Research ; Patient-Centered Care - standards ; Patient-Centered Care - trends ; Primary Health Care - standards ; Primary Health Care - trends ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Quality of care ; Reproducibility of Results</subject><ispartof>Journal of general internal medicine : JGIM, 2011-12, Vol.26 (12), p.1418-1425</ispartof><rights>Society of General Internal Medicine 2011</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c498t-1a653d39f34f6df77263434bf83c8de7ed8a2b631d0418beadf8be6d3fb498cd3</citedby><cites>FETCH-LOGICAL-c498t-1a653d39f34f6df77263434bf83c8de7ed8a2b631d0418beadf8be6d3fb498cd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3235610/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3235610/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,41464,42533,51294,53766,53768</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25305415$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21837377$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Birnberg, Jonathan M.</creatorcontrib><creatorcontrib>Drum, Melinda L.</creatorcontrib><creatorcontrib>Huang, Elbert S.</creatorcontrib><creatorcontrib>Casalino, Lawrence P.</creatorcontrib><creatorcontrib>Lewis, Sarah E.</creatorcontrib><creatorcontrib>Vable, Anusha M.</creatorcontrib><creatorcontrib>Tang, Hui</creatorcontrib><creatorcontrib>Quinn, Michael T.</creatorcontrib><creatorcontrib>Burnet, Deborah L.</creatorcontrib><creatorcontrib>Summerfelt, Thomas</creatorcontrib><creatorcontrib>Chin, Marshall H.</creatorcontrib><title>Development of a Safety Net Medical Home Scale for Clinics</title><title>Journal of general internal medicine : JGIM</title><addtitle>J GEN INTERN MED</addtitle><addtitle>J Gen Intern Med</addtitle><description>Background
Existing tools to measure patient-centered medical home (PCMH) adoption are not designed for research evaluation in safety-net clinics.
Objective
Develop a scale to measure PCMH adoption in safety-net clinics.
Research Design
Cross-sectional survey.
Subjects
Sixty-five clinics in five states.
Main Measures
Fifty-two-item Safety Net Medical Home Scale (SNMHS). The total score ranges from 0 (worst) to 100 (best) and is an average of multiple subscales (0–100): Access and Communication, Patient Tracking and Registry, Care Management, Test and Referral Tracking, Quality Improvement, and External Coordination. The scale was tested for internal consistency reliability and tested for convergent validity using The Assessment of Chronic Illness Care (ACIC) and the Patient-Centered Medical Home Assessment (PCMH-A). The scale was applied to centers in the sample. In addition, linear regression models were used to measure the association between clinic characteristics and medical home adoption.
Results
The SNMHS had high internal consistency reliability (Cronbach’s alpha = 0.84). The SNMHS score correlated moderately with the ACIC score (r = 0.64, p < 0.0001) and the PCMH-A (r = 0.56, p < 0.001). The mean SNMHS score was 61 ± SD 13. Among the subscales, External Coordination (66 ± 16) and Access and Communication (65 ± 14) had the highest mean scores, while Quality Improvement (55 ± 17) and Care Management (55 ± 16) had lower mean scores. Clinic characteristics positively associated with total SNMHS score were having more providers (β 15.8 95% CI 8.1–23.4 >8 provider FTEs compared to <4 FTEs) and participation in financial incentive programs (β 8.4 95% 1.6–15.3).
Conclusion
The SNMHS demonstrated reliability and convergent validity for measuring PCMH adoption in safety-net clinics. Some clinics have significant PCMH adoption. However, room for improvement exists in most domains, especially for clinics with fewer providers.</description><subject>Ambulatory Care Facilities - standards</subject><subject>Ambulatory Care Facilities - trends</subject><subject>Biological and medical sciences</subject><subject>Clinics</subject><subject>Community health care</subject><subject>Cross-Sectional Studies - methods</subject><subject>General aspects</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Miscellaneous</subject><subject>Original Research</subject><subject>Patient-Centered Care - standards</subject><subject>Patient-Centered Care - trends</subject><subject>Primary Health Care - standards</subject><subject>Primary Health Care - trends</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Quality of care</subject><subject>Reproducibility of Results</subject><issn>0884-8734</issn><issn>1525-1497</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kV9rFTEQxYNY7LX6AXyRIIhPWzNJNsn6IMj1TwtVH6rPIZtM6pbdzW2yt9Bv35R7bVXwJQnM78ycySHkBbBjYEy_LQCKqYYBNKCVbrpHZAUtbxuQnX5MVswY2Rgt5CF5WsolYyA4N0_IIQcjtNB6Rd59xGsc02bCeaEpUkfPXcTlhn7DhX7FMHg30pM0IT2vL6QxZboeh3nw5Rk5iG4s-Hx_H5Gfnz_9WJ80Z9-_nK4_nDVedmZpwKlWBNFFIaMKUWuuhBSyj0Z4E1BjMI73SkBgEkyPLsR6qiBiX_U-iCPyftd3s-0nDL46zW60mzxMLt_Y5Ab7d2UeftmLdG0FF60CVhu82TfI6WqLZbHTUDyOo5sxbYvtmOS8lVJX8tU_5GXa5rluVyFhJG-VqRDsIJ9TKRnjvRVg9i4Xu8vF1lzsXS62q5qXf-5wr_gdRAVe7wFX6kfH7GY_lAeuFayV0FaO77hSS_MF5geH_59-C6topJ8</recordid><startdate>20111201</startdate><enddate>20111201</enddate><creator>Birnberg, Jonathan M.</creator><creator>Drum, Melinda L.</creator><creator>Huang, Elbert S.</creator><creator>Casalino, Lawrence P.</creator><creator>Lewis, Sarah E.</creator><creator>Vable, Anusha M.</creator><creator>Tang, Hui</creator><creator>Quinn, Michael T.</creator><creator>Burnet, Deborah L.</creator><creator>Summerfelt, Thomas</creator><creator>Chin, Marshall H.</creator><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20111201</creationdate><title>Development of a Safety Net Medical Home Scale for Clinics</title><author>Birnberg, Jonathan M. ; Drum, Melinda L. ; Huang, Elbert S. ; Casalino, Lawrence P. ; Lewis, Sarah E. ; Vable, Anusha M. ; Tang, Hui ; Quinn, Michael T. ; Burnet, Deborah L. ; Summerfelt, Thomas ; Chin, Marshall H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c498t-1a653d39f34f6df77263434bf83c8de7ed8a2b631d0418beadf8be6d3fb498cd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Ambulatory Care Facilities - standards</topic><topic>Ambulatory Care Facilities - trends</topic><topic>Biological and medical sciences</topic><topic>Clinics</topic><topic>Community health care</topic><topic>Cross-Sectional Studies - methods</topic><topic>General aspects</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Miscellaneous</topic><topic>Original Research</topic><topic>Patient-Centered Care - standards</topic><topic>Patient-Centered Care - trends</topic><topic>Primary Health Care - standards</topic><topic>Primary Health Care - trends</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Quality of care</topic><topic>Reproducibility of Results</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Birnberg, Jonathan M.</creatorcontrib><creatorcontrib>Drum, Melinda L.</creatorcontrib><creatorcontrib>Huang, Elbert S.</creatorcontrib><creatorcontrib>Casalino, Lawrence P.</creatorcontrib><creatorcontrib>Lewis, Sarah E.</creatorcontrib><creatorcontrib>Vable, Anusha M.</creatorcontrib><creatorcontrib>Tang, Hui</creatorcontrib><creatorcontrib>Quinn, Michael T.</creatorcontrib><creatorcontrib>Burnet, Deborah L.</creatorcontrib><creatorcontrib>Summerfelt, Thomas</creatorcontrib><creatorcontrib>Chin, Marshall H.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of general internal medicine : JGIM</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Birnberg, Jonathan M.</au><au>Drum, Melinda L.</au><au>Huang, Elbert S.</au><au>Casalino, Lawrence P.</au><au>Lewis, Sarah E.</au><au>Vable, Anusha M.</au><au>Tang, Hui</au><au>Quinn, Michael T.</au><au>Burnet, Deborah L.</au><au>Summerfelt, Thomas</au><au>Chin, Marshall H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Development of a Safety Net Medical Home Scale for Clinics</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><stitle>J GEN INTERN MED</stitle><addtitle>J Gen Intern Med</addtitle><date>2011-12-01</date><risdate>2011</risdate><volume>26</volume><issue>12</issue><spage>1418</spage><epage>1425</epage><pages>1418-1425</pages><issn>0884-8734</issn><eissn>1525-1497</eissn><abstract>Background
Existing tools to measure patient-centered medical home (PCMH) adoption are not designed for research evaluation in safety-net clinics.
Objective
Develop a scale to measure PCMH adoption in safety-net clinics.
Research Design
Cross-sectional survey.
Subjects
Sixty-five clinics in five states.
Main Measures
Fifty-two-item Safety Net Medical Home Scale (SNMHS). The total score ranges from 0 (worst) to 100 (best) and is an average of multiple subscales (0–100): Access and Communication, Patient Tracking and Registry, Care Management, Test and Referral Tracking, Quality Improvement, and External Coordination. The scale was tested for internal consistency reliability and tested for convergent validity using The Assessment of Chronic Illness Care (ACIC) and the Patient-Centered Medical Home Assessment (PCMH-A). The scale was applied to centers in the sample. In addition, linear regression models were used to measure the association between clinic characteristics and medical home adoption.
Results
The SNMHS had high internal consistency reliability (Cronbach’s alpha = 0.84). The SNMHS score correlated moderately with the ACIC score (r = 0.64, p < 0.0001) and the PCMH-A (r = 0.56, p < 0.001). The mean SNMHS score was 61 ± SD 13. Among the subscales, External Coordination (66 ± 16) and Access and Communication (65 ± 14) had the highest mean scores, while Quality Improvement (55 ± 17) and Care Management (55 ± 16) had lower mean scores. Clinic characteristics positively associated with total SNMHS score were having more providers (β 15.8 95% CI 8.1–23.4 >8 provider FTEs compared to <4 FTEs) and participation in financial incentive programs (β 8.4 95% 1.6–15.3).
Conclusion
The SNMHS demonstrated reliability and convergent validity for measuring PCMH adoption in safety-net clinics. Some clinics have significant PCMH adoption. However, room for improvement exists in most domains, especially for clinics with fewer providers.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>21837377</pmid><doi>10.1007/s11606-011-1767-9</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of general internal medicine : JGIM, 2011-12, Vol.26 (12), p.1418-1425 |
| issn | 0884-8734 1525-1497 |
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| source | MEDLINE; Springer Nature - Complete Springer Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Ambulatory Care Facilities - standards Ambulatory Care Facilities - trends Biological and medical sciences Clinics Community health care Cross-Sectional Studies - methods General aspects Humans Internal Medicine Medical sciences Medicine Medicine & Public Health Miscellaneous Original Research Patient-Centered Care - standards Patient-Centered Care - trends Primary Health Care - standards Primary Health Care - trends Public health. Hygiene Public health. Hygiene-occupational medicine Quality of care Reproducibility of Results |
| title | Development of a Safety Net Medical Home Scale for Clinics |
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