title: Varied Rates of Implementation of Patient-Centered Medical Home Features and Residents' Perceptions of Their Importance Based on Practice Experience.
abstract: OBJECTIVE
  Little is known about how the patient-centered medical home (PCMH) is being implemented in residency practices. We describe both the trends in implementation of PCMH features and the influence that working with PCMH features has on resident attitudes toward their importance in 14 family medicine residencies associated with the P4 Project.
  
  
  METHODS
  We assessed 24 residency continuity clinics annually between 2007-2011 on presence or absence of PCMH features. Annual resident surveys (n=690) assessed perceptions of importance of PCMH features using a 4-point scale (not at all important to very important). We used generalized estimating equations logistic regression to assess trends and ordinal-response proportional odds regression models to determine if resident ratings of importance were associated with working with those features during training.
  
  
  RESULTS
  Implementation of electronic health record (EHR) features increased significantly from 2007-2011, such as email communication with patients (33% to 67%), preventive services registries (23% to 64%), chronic disease registries (63% to 82%), and population-based quality assurance (46% to 79%). Team-based care was the only process of care feature to change significantly (54% to 93%). Residents with any exposure to EHR-based features had higher odds of rating the features more important compared to those with no exposure. We observed consistently lower odds of the resident rating process of care features as more important with any exposure compared to no exposure.
  
  
  CONCLUSIONS
  Residencies engaged in educational transformation were more successful in implementing EHR-based PCMH features, and exposure during training appears to positively influence resident ratings of importance, while exposure to process of care features are slower to implement with less influence on importance ratings.
authors.affiliation: Department of Family Medicine, Oregon Health & Science University.
authors.forename: M Patrice
authors.initials: MP
authors.lastname: Eiff
authors.forename: Larry A
authors.initials: LA
authors.lastname: Green
authors.forename: Geoff
authors.initials: G
authors.lastname: Jones
authors.forename: Alex Verdieck
authors.initials: AV
authors.lastname: Devlaeminck
authors.forename: Elaine
authors.initials: E
authors.lastname: Waller
authors.forename: Eve
authors.initials: E
authors.lastname: Dexter
authors.forename: Miguel
authors.initials: M
authors.lastname: Marino
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Carney
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005194:Family Practice / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D010820:Physicians / Q000523:psychology*; D011320:Primary Health Care