Perceptions of high-risk patients and their providers on the patient-centered medical home.
To explore perceptions of high-risk patients and their practice staff on the patient-centered medical home, we conducted a multisite qualitative study with chronically ill, low-income patients and their primary care practice staff (N = 51). There were 3 key findings. Both patients and staff described a trade-off: timely care from an unfamiliar provider versus delayed access to their personal physician. Staff were enthusiastic about enhancing access through strategies such as online communication, yet high-risk patients viewed these as access barriers. Practices lacked capacity to manage high-risk patients and therefore frequently referred them to the emergency room.
Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (Drs Kangovi, Long, and Grande); Penn Center for Community Health Workers, Philadelphia, Pennsylvania (Dr Kangovi and Mr Chanton); Spectrum Health Services, Inc, Philadelphia, Pennsylvania (Dr Kangovi); Philadelphia VA Center for Health Equities Research and Promotion, Philadelphia, Pennsylvania (Drs Kangovi and Long); University of Pennsylvania, Mixed Methods Research Laboratory, Philadelphia (Mss Kellom and Carter); Department of Medicine, University of San Francisco, San Francisco, California (Dr Sha); Leonard Davis Institute of Health Economics. University of Pennsylvania, Philadelphia (Dr Grande); and Department of Internal Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Johnson).
Shreya
S
Kangovi
Katherine
K
Kellom
Christopher
C
Sha
Sarah
S
Johnson
Casey
C
Chanton
Tamala
T
Carter
Judith A
JA
Long
David
D
Grande
D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care; D010361:Patients / Q000523:psychology*; D015143:Philadelphia; D011320:Primary Health Care; D036301:Qualitative Research