title: Using fuzzy set qualitative comparative analysis (fs/QCA) to explore the relationship between medical "homeness" and quality.
abstract: OBJECTIVE
  Determine, using fuzzy set qualitative comparative analysis (fs/QCA), the relationship between patient-centered medical home (PCMH) systems and quality in 21 NCQA recognized medical homes.
  
  
  METHODS
  Primary data collected in 2009, including measures of optimal diabetes care (ODC), preventive services up-to-date (PSUTD), patient experience (PEX), survey data assessing PCMH capabilities (PPC-RS), and other clinic characteristics.
  
  
  METHODS
  Cross-sectional study identifying associations between PPC-RS domains, demographic, socioeconomic, and co-morbidity measures, and quality outcomes.
  
  
  METHODS
  PPC-RS scores were obtained by surveying clinic leaders. PSUTD and ODC scores were obtained from provider performance data. PEX data were obtained from patient surveys. Demographic, socioeconomic, and co-morbidity data were obtained from EMR and census data.
  
  
  RESULTS
  fs/QCA identified associations between all three outcomes and PCMH capabilities: ODC and team-based care; PSUTD and preventive services systems; and all three outcomes and provider performance reporting systems. Previous statistical analysis of this data had failed to identify these relationships.
  
  
  CONCLUSIONS
  fs/QCA identified important associations that were overlooked using conventional statistics in a small-N health services data set. PCMH capabilities are associated with quality outcomes.
authors.affiliation: Center for Healthcare Innovation, Allina Hospitals & Clinics, Minneapolis, MN 55407-1321, USA. marcus.thygeson@allina.com
authors.forename: Nels
authors.initials: N
authors.lastname: Marcus Thygeson
authors.forename: Leif I
authors.initials: LI
authors.lastname: Solberg
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Asche
authors.forename: Patricia
authors.initials: P
authors.lastname: Fontaine
authors.forename: Leonard
authors.initials: L
authors.lastname: Gregory Pawlson
authors.forename: Sarah Hudson
authors.initials: SH
authors.lastname: Scholle
mesh_terms: D000367:Age Factors; D000368:Aged; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D017143:Fuzzy Logic; D006801:Humans; D008297:Male; D015146:Midwestern United States; D017063:Outcome Assessment, Health Care / Q000592:standards; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000458:organization & administration / Q000592:standards*; D011315:Preventive Medicine / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care / Q000592:standards; D012737:Sex Factors; D012959:Socioeconomic Factors
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