title: Readiness of primary care practices for medical home certification.
abstract: OBJECTIVE
  To assess the prevalence of medical home infrastructure among primary care practices for children and identify practice characteristics associated with medical home infrastructure.
  
  
  METHODS
  Cross-sectional analysis of restricted data files from 2007 and 2008 of the National Ambulatory Medical Care Survey. We mapped survey items to the 2011 National Committee on Quality Assurance's Patient-Centered Medical home standards. Points were awarded for each "passed" element based on National Committee for Quality Assurance scoring, and we then calculated the percentage of the total possible points met for each practice. We used multivariate linear regression to assess associations between practice characteristics and the percentage of medical home infrastructure points attained.
  
  
  RESULTS
  On average, pediatric practices attained 38% (95% confidence interval 34%-41%) of medical home infrastructure points, and family/general practices attained 36% (95% confidence interval 33%-38%). Practices scored higher on medical home elements related to direct patient care (eg, providing comprehensive health assessments) and lower in areas highly dependent on health information technology (eg, computerized prescriptions, test ordering, laboratory result viewing, or quality of care measurement and reporting). In multivariate analyses, smaller practice size was significantly associated with lower infrastructure scores. Practice ownership, urban versus rural location, and proportion of visits covered by public insurers were not consistently associated with a practice's infrastructure score.
  
  
  CONCLUSIONS
  Medical home programs need effective approaches to support practice transformation in the small practices that provide the vast majority of the primary care for children in the United States.
authors: Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI, USA. jzickafoose@mathematica-mpr.com
authors: Joseph S
authors: JS
authors: Zickafoose
authors: Sarah J
authors: SJ
authors: Clark
authors: Joseph W
authors: JW
authors: Sakshaug
authors: Lena M
authors: LM
authors: Chen
authors: John M
authors: JM
authors: Hollingsworth
mesh_terms: D002568:Certification / Q000379:methods / Q000592:standards*; D002648:Child; D003430:Cross-Sectional Studies; D019538:Health Care Surveys / Q000379:methods*; D006801:Humans; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards*; D011320:Primary Health Care / Q000379:methods / Q000592:standards*
references: N Engl J Med. 2009 Dec 24;361(26):2503-5
references: 19940285
references: Manag Care. 2009 Jun;18(6):44-8
references: 19569570
references: Adv Data. 2007 Mar 12;(383):1-15
references: 17370700
references: JAMA. 2009 Jun 24;301(24):2589-91
references: 19549977
references: J Gen Intern Med. 2010 Jun;25(6):584-92
references: 20467907
references: Med Care Res Rev. 2010 Aug;67(4):431-49
references: 20448254
references: Ann Fam Med. 2010;8 Suppl 1:S21-32; S92
references: 20530392
references: Health Aff (Millwood). 2008 Sep-Oct;27(5):1246-58
references: 18780907
references: Ann Fam Med. 2009 Jul-Aug;7(4):301-8
references: 19597167
references: JAMA. 2009 May 20;301(19):2038-40
references: 19454643
references: J Gen Intern Med. 2009 Feb;24(2):162-9
references: 19050977
references: Health Aff (Millwood). 2011 Aug;30(8):1575-84
references: 21719447
references: Health Serv Res. 2012 Feb;47(1 Pt 2):486-508
references: 22091559
references: Health Aff (Millwood). 2010 Jun;29(6):1194-9
references: 20530354
references: Ann Fam Med. 2010;8 Suppl 1:S80-90; S92
references: 20530397
references: Med Care. 2009 Jul;47(7):714-22
references: 19536005
references: Health Aff (Millwood). 2011 Mar;30(3):439-45
references: 21383361
references: Health Aff (Millwood). 2011 Mar;30(3):383-6
references: 21383346
references: Issue Brief Cent Stud Health Syst Change. 2011 Aug;(136):1-4
references: 21853632
references: Health Aff (Millwood). 2009 May-Jun;28(3):w510-9
references: 19401290
references: N Engl J Med. 2009 Jun 25;360(26):2693-6
references: 19553643
references: Arch Intern Med. 2010 Jun 14;170(11):938-44
references: 20548005