title: Patient-centered medical home intervention at an internal medicine resident safety-net clinic.
abstract: OBJECTIVE
  The patient-centered medical home (PCMH) model holds promise for improving primary care delivery, but it has not been adequately tested in teaching settings.
  
  
  METHODS
  We implemented an intervention guided by PCMH principles at a safety-net teaching clinic with resident physician providers. Two similar clinics served as controls.
  
  
  METHODS
  Using a cross-sectional design, we measured the effect on patient and resident satisfaction using the Consumer Assessment of Healthcare Providers and Systems survey and a validated teaching clinic survey, respectively. Both surveys were conducted at baseline and 1 year after the intervention. We also measured the effect on emergency department and hospital utilization.
  
  
  RESULTS
  Following implementation of our intervention, the clinic’s score on the National Committee for Quality Assurance’s PCMH certification tool improved from 35 to 53 of 100 possible points, although our clinic did not achieve all must-pass elements to qualify as a PCMH. During the 1-year study period, 4676 patients were exposed to the intervention; 39.9% of these used at least 1 program component. Compared with baseline, patient-reported access and overall satisfaction improved to a greater extent in the intervention clinic, and the composite satisfaction rating increased from 48% to 65% in the intervention clinic vs from 50% to 59% in the control sites (P = .04). The improvements were particularly notable for questions relating to access. For example, satisfaction with urgent appointment scheduling increased from 12% to 53% in the intervention clinic vs from 14% to 18% in the control clinics (P < .001). Resident satisfaction also improved in the intervention clinic: the composite satisfaction score increased from 39% to 51% in the intervention clinic vs a decrease from 46% to 42% in the control clinics (P = .01). Emergency department utilization did not differ significantly between the intervention and control clinics, and hospitalizations increased from 26 to 27 visits per 1000 patients per month in the intervention clinic vs a decrease from 28 to 25 in the control clinics (P = .02).
  
  
  CONCLUSIONS
  Our PCMH-guided intervention, which represented a modest but substantive step toward the PCMH vision, had favorable effects on patient and resident satisfaction at a safety-net teaching clinic but did not reduce emergency department or hospital utilization in the first year. Our experience may provide lessons for other teaching clinics in safety-net settings hoping to implement PCMH-guided reforms.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Hochman
authors.forename: Steven
authors.initials: S
authors.lastname: Asch
authors.forename: Arek
authors.initials: A
authors.lastname: Jibilian
authors.forename: Bharat
authors.initials: B
authors.lastname: Chaudry
authors.forename: Ron
authors.initials: R
authors.lastname: Ben-Ari
authors.forename: Eric
authors.initials: E
authors.lastname: Hsieh
authors.forename: Margaret
authors.initials: M
authors.lastname: Berumen
authors.forename: Shahrod
authors.initials: S
authors.lastname: Mokhtari
authors.forename: Mohamad
authors.initials: M
authors.lastname: Raad
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Hicks
authors.forename: Crystal
authors.initials: C
authors.lastname: Sanford
authors.forename: Norma
authors.initials: N
authors.lastname: Aguirre
authors.forename: Chi-hong
authors.initials: CH
authors.lastname: Tseng
authors.forename: Sitaram
authors.initials: S
authors.lastname: Vangala
authors.forename: Carol M
authors.initials: CM
authors.lastname: Mangione
authors.forename: David A
authors.initials: DA
authors.lastname: Goldstein
mesh_terms: D000554:Ambulatory Care Facilities; D001071:Appointments and Schedules; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration*; D004501:Education, Medical / Q000379:methods*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000379:methods*; D064876:Safety-net Providers / Q000379:methods*; D014481:United States