Principles of the patient-centered medical home and preventive services delivery.
OBJECTIVE
Limited research exists examining the principles of the patient-centered medical home (PCMH) and improved outcomes. We examined whether PCMH principles (personal physician, physician-directed team, whole-person orientation, coordination of care, quality and safety, and enhanced access) are associated with receipt of preventive services.


METHODS
We undertook cross-sectional analyses using baseline patient and practice member surveys and chart audits from a quality improvement trial in 24 primary care offices. Association of PCMH principles with preventive services (receipt of cancer screening, lipid screening, influenza vaccination, and behavioral counseling) was examined using hierarchical linear modeling.


RESULTS
Higher global PCMH scores were associated with receipt of preventive services (beta = 2.3; P <.001). Positive associations were found with principles of personal physician (beta = 3.7; P <.001), in particular, continuity with the same physician (beta = 4.4; P = .002) and number of visits within 2 years (15% higher for patients with 13 or more visits; P <.001); and whole-person orientation (beta = 5.6; P <.001), particularly, having a well-visit within 5 years (beta = 12.3; P <.001) and being treated for chronic diseases (6% higher if more than 3 chronic diseases; P = .002). Having referral systems to link patients to community programs for preventive counseling (beta = 8.0; P <.001) and use of clinical decision-support tools (beta = 5.0; P = .04) were also associated with receipt of preventive services.


CONCLUSIONS
Relationship-centered aspects of PCMH are more highly correlated with preventive services delivery in community primary care practices than are information technology capabilities. Demonstration projects and tools that measure PCMH principles should have greater emphasis on these key primary care attributes.
Ferrante
Jeanne M
JM
Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA. ferranjm@umdnj.edu
Balasubramanian
Bijal A
BA
Hudson
Shawna V
SV
Crabtree
Benjamin F
BF
D000368:Aged; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D005194:Family Practice / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D018166:Health Care Reform / Q000379:methods; D006293:Health Promotion; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009515:New Jersey; D009936:Organizational Innovation; D018802:Patient-Centered Care / Q000379:methods*; D010817:Physician-Patient Relations; D011314:Preventive Health Services / Q000379:methods* / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires; D014481:United States