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Development of a Safety Net Medical Home Scale for Clinics

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Journal of General Internal Medicine Aims and scope Submit manuscript

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.

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Contributors

The authors thank Qualis Health and the MacColl Institute for Healthcare Innovation at the Group Health Research Institute for sharing the following data that was collected from clinics: the Assessment of Chronic Illness Care, PCMH-A, and the clinic demographics. The authors also thank David Stevens, MD, Director for Quality at the National Association of Community Health Centers for his review of the manuscript, and Kenneth Rasinski, PhD, for his advice and guidance on scale development.

Funders

This project was supported by the Commonwealth Fund, a national, private foundation based in New York City that supports independent research on health care issues and makes grants to improve health care practice and policy. The views presented here are those of the author and not necessarily those of The Commonwealth Fund, its directors, officers, or staff. Dr. Birnberg is supported by a Postdoctoral Fellowship in Health Services Research AHRQ T32- 5T32 HS00084-12. Dr. Chin is supported by a Midcareer Investigator Award in Patient-Oriented Research from the National Institute of Diabetes and Digestive and Kidney Diseases (K24 DK071933) and the National Institute of Diabetes and Digestive and Kidney Diseases Diabetes Research and Training Center (P60 DK20595).

Prior Presentations

Dr. Birnberg has presented this material at the Society of General Internal Medicine Annual Meeting Minneapolis, MN, April 2010 and Phoenix, AZ, May 2011.

Conflict of Interest

Dr. Birnberg reports acting as a consultant for Engaged Health Solutions LLC, a worksite wellness company. Dr. Huang reports acting as a consultant for the National Changing Diabetes Program of Novo Nordisk in 2008. Marshall Chin is the principal Investigator (Multiple PI with Monica Peek, MD, MPH) for Improving Diabetes Care and Outcomes on the South Side of Chicago, funded by the Merck Company Foundation ($1,818,179). The Merck Company Foundation, is a US-based, private charitable foundation. Established in 1957 by Merck & Co., Inc., a global research-driven pharmaceutical company, the Foundation is funded entirely by the company and is Merck's chief source of funding support to qualified non-profit, charitable organizations. The mission of the Foundation is to support organizations and innovative programs that: expand access to medicines, vaccines, and quality health care; build capacity in the biomedical and health sciences; promote environments that encourage innovation, economic growth, and development in a fair and ethical context; and support communities where Merck has a major presence. Since its inception, The Merck Company Foundation has contributed more than US$420 million to support important initiatives that address societal needs and are consistent with Merck's overall mission to enhance the health and well-being of people around the world. All other authors report no conflict of interest.

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Authors and Affiliations

  1. Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA

    Jonathan M. Birnberg MD, Elbert S. Huang MD MPH, Sarah E. Lewis MSPH, Anusha M. Vable MPH, Hui Tang MS, Michael T. Quinn PhD, Deborah L. Burnet MD MA & Marshall H. Chin MD MPH

  2. Department of Health Studies, University of Chicago, Chicago, IL, USA

    Melinda L. Drum PhD

  3. Weill Cornell Medical College, New York, NY, USA

    Lawrence P. Casalino MD PhD

  4. Advocate Health Care System, Oak Brook, IL, USA

    Thomas Summerfelt PhD

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  1. Jonathan M. Birnberg MD
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Correspondence to Jonathan M. Birnberg MD.

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Birnberg, J.M., Drum, M.L., Huang, E.S. et al. Development of a Safety Net Medical Home Scale for Clinics. J GEN INTERN MED 26, 1418–1425 (2011). https://doi.org/10.1007/s11606-011-1767-9

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