title: Measuring patient-centered medical home access and continuity in clinics with part-time clinicians.
abstract: OBJECTIVE
  Common patient-centered medical home (PCMH) performance measures value access to a single primary care provider (PCP), which may have unintended consequences for clinics that rely on part-time PCPs and team-based care.
  
  
  METHODS
  Retrospective analysis of 110,454 primary care visits from 2 Veterans Health Administration clinics from 2010 to 2012. Multi-level models examined associations between PCP availability in clinic, and performance on access and continuity measures. Patient experiences with access and continuity were compared using 2012 patient survey data (N = 2881).
  
  
  RESULTS
  Patients of PCPs with fewer half-day clinic sessions per week were significantly less likely to get a requested same-day appointment with their usual PCP (predicted probability 17% for PCPs with 2 sessions/week, 20% for 5 sessions/week, and 26% for 10 sessions/week). Among requests that did not result in a same-day appointment with the usual PCP, there were no significant differences in same-day access to a different PCP, or access within 2 to 7 days with patients' usual PCP. Overall, patients had >92% continuity with their usual PCP at the hospital-based site regardless of PCP sessions/week. Patients of full-time PCPs reported timely appointments for urgent needs more often than patients of part-time PCPs (82% vs 71%; P < .01), but reported similar experiences with routine access and continuity.
  
  
  CONCLUSIONS
  Part-time PCP performance appeared worse when using measures focused on same-day access to patients' usual PCP. However, clinic-level same-day access, same-week access to the usual PCP, and overall continuity were similar for patients of part-time and full-time PCPs. Measures of in-person access to a usual PCP do not capture alternate access approaches encouraged by PCMH, and often used by part-time providers, such as team-based or non-face-to-face care.
authors.affiliation: 2800 Plymouth Rd, Building 16, 3rd Fl, Ann Arbor, MI 48109. E-mail: arosland@umich.edu.
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Rosland
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Krein
authors.forename: Hyunglin Myra
authors.initials: HM
authors.lastname: Kim
authors.forename: Clinton L
authors.initials: CL
authors.lastname: Greenstone
authors.forename: Adam
authors.initials: A
authors.lastname: Tremblay
authors.forename: David
authors.initials: D
authors.lastname: Ratz
authors.forename: Darcy
authors.initials: D
authors.lastname: Saffar
authors.forename: Eve A
authors.initials: EA
authors.lastname: Kerr
mesh_terms: D001071:Appointments and Schedules; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000458:organization & administration; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration