title: Patient-centered medical home transformation with payment reform: patient experience outcomes.
abstract: OBJECTIVE
  To examine changes in patient experience across key domains of the patient-centered medical home (PCMH) following practice transformation with Lean quality improvement methodology inclusive of payment reform.
  
  
  METHODS
  Pre-intervention/post-intervention analysis of intervention with a comparison group, a quasi-experimental design. We surveyed patients following office visits at the intervention (n = 2502) and control (n = 1622) practices during the 15-month period before and 14-month period after PCMH Lean transformation (April-October 2009).
  
  
  METHODS
  We measured and compared pre-intervention and post-intervention levels of patient satisfaction and other indicators of patient-centered care. Propensity weights adjusted for potential case-mix differences in intervention and control groups; propensity-adjusted proportions accounted for physician-level clustering.
  
  
  RESULTS
  More intervention patients were very satisfied with their care after the PCMH Lean intervention (68%) compared with pre-intervention (62%). Among control patients, there was no corresponding increase in satisfaction (63% very satisfied pre-intervention vs 64% very satisfied post-intervention). This comparison resulted in a statistical trend (P = .10) toward greater overall satisfaction attributable to the intervention. Post-intervention, patients in the intervention practice consistently rated indicators of patient-centered care higher than patients in the control practice, particularly in the personal physician and communication domain. In this domain, intervention patients reported superior provider explanations, time spent, provider concern, and follow-up instructions compared with control participants, whereas control group ratings fell in the post-intervention period (P for difference <.05).
  
  
  CONCLUSIONS
  In a pilot PCMH transformation including Lean enhancement with payment reform, patient experience was sustained or improved across key PCMH domains.
authors: VA Boston Healthcare System, 150 South Huntington Ave, Bldg 9 (152G), Boston, MA 02130.
authors: Leonie
authors: L
authors: Heyworth
authors: Asaf
authors: A
authors: Bitton
authors: Stuart R
authors: SR
authors: Lipsitz
authors: Thad
authors: T
authors: Schilling
authors: Gordon D
authors: GD
authors: Schiff
authors: David W
authors: DW
authors: Bates
authors: Steven R
authors: SR
authors: Simon
mesh_terms: D003953:Diagnosis-Related Groups; D018166:Health Care Reform / Q000191:economics*; D006801:Humans; D008404:Massachusetts; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000191:economics*; D010865:Pilot Projects; D058996:Quality Improvement