title: Conformity of pediatric/adolescent HIV clinics to the patient-centered medical home care model.
abstract: The patient-centered medical home (PCMH) has been introduced as a model for providing high-quality, comprehensive, patient-centered care that is both accessible and coordinated, and may provide a framework for optimizing the care of youth living with HIV (YLH). We surveyed six pediatric/adolescent HIV clinics caring for 578 patients (median age 19 years, 51% male, and 82% black) in July 2011 to assess conformity to the PCMH. Clinics completed a 50-item survey covering the six domains of the PCMH: (1) comprehensive care, (2) patient-centered care, (3) coordinated care, (4) accessible services, (5) quality and safety, and (6) health information technology. To determine conformity to the PCMH, a novel point-based scoring system was devised. Points were tabulated across clinics by domain to obtain an aggregate assessment of PCMH conformity. All six clinics responded. Overall, clinics attained a mean 75.8% [95% CI, 63.3-88.3%] on PCMH measures-scoring highest on patient-centered care (94.7%), coordinated care (83.3%), and quality and safety measures (76.7%), and lowest on health information technology (70.0%), accessible services (69.1%), and comprehensive care (61.1%). Clinics moderately conformed to the PCMH model. Areas for improvement include access to care, comprehensive care, and health information technology. Future studies are warranted to determine whether greater clinic PCMH conformity improves clinical outcomes and cost savings for YLH.
authors: Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA. byehia@upenn.edu
authors: Baligh R
authors: BR
authors: Yehia
authors: Allison L
authors: AL
authors: Agwu
authors: Asher
authors: A
authors: Schranz
authors: P Todd
authors: PT
authors: Korthuis
authors: Aditya H
authors: AH
authors: Gaur
authors: Richard
authors: R
authors: Rutstein
authors: Victoria
authors: V
authors: Sharp
authors: Stephen A
authors: SA
authors: Spector
authors: Stephen A
authors: SA
authors: Berry
authors: Kelly A
authors: KA
authors: Gebo
mesh_terms: D000293:Adolescent; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D015658:HIV Infections / Q000628:therapy; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008490:Medical Informatics; D018802:Patient-Centered Care / Q000592:standards*; D010372:Pediatrics; D008486:Physician Executives; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D017064:Process Assessment, Health Care; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D055815:Young Adult
references: AIDS Care. 2005 Oct;17(7):902-7
references: 16120506
references: AIDS Patient Care STDS. 2008 Dec;22(12):1007-13
references: 19072107
references: AIDS. 2012 Jun 1;26(9):1131-9
references: 22382143
references: Ann Intern Med. 1999 Jul 20;131(2):81-7
references: 10419445
references: AIDS Patient Care STDS. 2012 Jun;26(6):344-55
references: 22612447
references: Top HIV Med. 2008 Dec;16(5):156-61
references: 19106431
references: J Am Geriatr Soc. 2008 Dec;56(12):2195-202
references: 19093919
references: Health Aff (Millwood). 2008 Sep-Oct;27(5):1219-30
references: 18780904
references: J Pediatr Psychol. 2010 Oct;35(9):1011-5
references: 20144940
references: AIDS Patient Care STDS. 2009 Jan;23(1):41-9
references: 19055408
references: AIDS Patient Care STDS. 2012 Nov;26(11):647-54
references: 23134559
references: AIDS Patient Care STDS. 2012 Aug;26(8):454-62
references: 22742455
references: J Adolesc Health. 2000 Nov;27(5):293-4
references: 11044698
references: AIDS Patient Care STDS. 2007;21 Suppl 1:S49-58
references: 17563290
references: AIDS Care. 2007 Feb;19(2):248-51
references: 17364406
references: Matern Child Health J. 2003 Dec;7(4):205-18
references: 14682498
references: Clin Infect Dis. 2011 Jan 15;52 Suppl 2:S214-22
references: 21342910
references: J Adolesc Health. 1998 Aug;23(2 Suppl):1-4
references: 9712248
references: AIDS Patient Care STDS. 2012 Mar;26(3):165-72
references: 22248331
references: J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Jan 1;17(1):35-41
references: 9436756
references: Health Aff (Millwood). 2010 May;29(5):835-43
references: 20439869
references: J Adolesc Health. 2002 Jul;31(1 Suppl):28-39
references: 12093609
references: AIDS. 2013 Jun 19;27(10):1529-33
references: 23435297
references: Ann Intern Med. 2012 Jul 3;157(1):29-43
references: 22751758
references: AIDS Care. 2002 Aug;14 Suppl 1:S45-57
references: 12204141
references: Clin Infect Dis. 2003 Oct 15;37(8):1112-8
references: 14523777
references: PLoS One. 2011;6(8):e17502
references: 21826193
references: Ann Fam Med. 2006 Jan-Feb;4(1):69-74
references: 16449399
references: Ann Fam Med. 2010 Nov-Dec;8(6):493-8
references: 21060118
references: JAMA. 2003 Feb 26;289(8):1035-40
references: 12597760
references: J Adolesc Health. 2010 Mar;46(3):278-83
references: 20159506
references: Pediatrics. 2005 Jul;116(1):82-7
references: 15995036
references: J Adolesc Health. 1997 Nov;21(5):287-90
references: 9358291
references: Ann Fam Med. 2005 May-Jun;3(3):209-14
references: 15928223
references: AIDS Behav. 2012 May;16(4):900-10
references: 22350832
references: J Acquir Immune Defic Syndr. 2011 Dec 1;58(4):e113-5
references: 22033235
references: Clin Infect Dis. 2007 Jun 1;44(11):1493-9
references: 17479948
references: Annu Rev Med. 2010;61:169-85
references: 19622036
references: N Engl J Med. 2003 Jun 26;348(26):2635-45
references: 12826639
references: Health Serv Res. 1994 Oct;29(4):489-510
references: 7928374
references: Clin Infect Dis. 2008 Aug 15;47(4):577-84
references: 18624629
references: Clin Infect Dis. 2009 Jan 15;48(2):248-56
references: 19072715
references: JAMA. 2007 Dec 12;298(22):2623-33
references: 18073358
references: AIDS Care. 2002 Aug;14 Suppl 1:S15-29
references: 12204139
references: Int Emerg Nurs. 2011 Oct;19(4):168-72
references: 21968408
references: Arch Intern Med. 2011 Jul 11;171(13):1150-9
references: 21518935
references: J Med Internet Res. 2012 Apr 05;14(2):e51
references: 22481246
references: AIDS Care. 2009 Oct;21(10):1289-97
references: 20024705
references: J Am Med Inform Assoc. 2008 Sep-Oct;15(5):585-600
references: 18579832