title: Quality, satisfaction, and financial efficiency associated with elements of primary care practice transformation: preliminary findings.
abstract: OBJECTIVE
  We examined quality, satisfaction, financial, and productivity outcomes associated with implementation of Care by Design (CBD), the University of Utah's version of the patient-centered medical home.
  
  
  METHODS
  We measured the implementation of individual elements of CBD using a combination of observation, chart audit, and collection of data from operational reports. We assessed correlations between level of implementation of each element and measures of quality, patient and clinician satisfaction, financial performance, and efficiency.
  
  
  RESULTS
  Team function elements had positive correlations (P ≤.05) with 6 quality measures, 4 patient satisfaction measure, and 3 clinician satisfaction measures. Continuity elements had positive correlations with 2 satisfaction measures and 1 quality measure. Clinician continuity was the key driver in the composite element of appropriate access. Unexpected findings included the negative correlation of use of templated questionnaires with 3 patient satisfaction measures. Trade-offs were observed for performance of blood draws in the examination room and the efficiency of visits, with some positive and some negative correlations depending on the outcome.
  
  
  CONCLUSIONS
  Elements related to care teams and continuity appear to be key elements of CBD as they influence all 3 CBD organizing principles: appropriate access, care teams, and planned care. These relationships, as well as unexpected, unfavorable ones, require further study and refined analyses to identify causal associations.
authors.affiliation: Community Clinics, University of Utah Hospitals and Clinics, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Day
authors.forename: Debra L
authors.initials: DL
authors.lastname: Scammon
authors.forename: Jaewhan
authors.initials: J
authors.lastname: Kim
authors.forename: Annie
authors.initials: A
authors.lastname: Sheets-Mervis
authors.forename: Rachel
authors.initials: R
authors.lastname: Day
authors.forename: Andrada
authors.initials: A
authors.lastname: Tomoaia-Cotisel
authors.forename: Norman J
authors.initials: NJ
authors.lastname: Waitzman
authors.forename: Michael K
authors.initials: MK
authors.lastname: Magill
mesh_terms: D016390:Allied Health Occupations; D019058:Community Networks / Q000458:organization & administration; D003266:Continuity of Patient Care; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D007588:Job Satisfaction; D010348:Patient Care Team; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000191:economics / Q000458:organization & administration*; D058007:Physicians, Primary Care / Q000523:psychology; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D011787:Quality of Health Care
keywords: finances; patient-centered medical home; practice-based research; primary care; quality; satisfaction