Medical home capabilities of primary care practices that serve sociodemographically vulnerable neighborhoods.
BACKGROUND
Under current medical home proposals, primary care practices using specific structural capabilities will receive enhanced payments. Some practices disproportionately serve sociodemographically vulnerable neighborhoods. If these practices lack medical home capabilities, their ineligibility for enhanced payments could worsen disparities in care.


METHODS
Via survey, 308 Massachusetts primary care practices reported their use of 13 structural capabilities commonly included in medical home proposals. Using geocoded US Census data, we constructed racial/ethnic minority and economic disadvantage indices to describe the neighborhood served by each practice. We compared the structural capabilities of "disproportionate-share" practices (those in the most sociodemographically vulnerable quintile on each index) and others.


RESULTS
Racial/ethnic disproportionate-share practices were more likely than others to have staff assisting patient self-management (69% vs 55%; P = .003), on-site language interpreters (54% vs 26%; P < .001), multilingual clinicians (80% vs 51%; P < .001), and multifunctional electronic health records (48% vs 29%; P = .01). Similarly, economic disproportionate-share practices were more likely than others to have physician awareness of patient experience ratings (73% vs 65%; P = .03), on-site language interpreters (56% vs 25%; P < .001), multilingual clinicians (78% vs 51%; P < .001), and multifunctional electronic health records (40% vs 31%; P = .03). Disproportionate-share practices were larger than others. After adjustment for practice size, only language capabilities continued to have statistically significant relationships with disproportionate-share status.


CONCLUSIONS
Contrary to expectations, primary care practices serving sociodemographically vulnerable neighborhoods were more likely than other practices to have structural capabilities commonly included in medical home proposals. Payments tied to these capabilities may aid practices serving vulnerable populations.
Friedberg
Mark W
MW
Division of General Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA.
Coltin
Kathryn L
KL
Safran
Dana Gelb
DG
Dresser
Marguerite
M
Schneider
Eric C
EC
D006801:Humans; D008404:Massachusetts; D018802:Patient-Centered Care / Q000458:organization & administration*; D010821:Physicians, Family / Q000600:supply & distribution*; D011320:Primary Health Care; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D035862:Vulnerable Populations; D000078329:Workforce