title: Patient experience midway through a large primary care practice transformation initiative.
abstract: OBJECTIVE
  To determine how the multipayer Comprehensive Primary Care (CPC) initiative that transforms primary care delivery affects the patient experience of Medicare fee-for-service beneficiaries. The study examines how experience changed between the first and second years of CPC, how ratings of CPC practices have changed relative to ratings of comparison practices, and areas in which practices still have opportunities to improve patient experience.
  
  
  METHODS
  Prospective study using 2 serial cross-sectional samples of more than 25,000 Medicare fee-for-service beneficiaries attributed to 496 CPC practices and nearly 9000 beneficiaries attributed to 792 comparison practices.
  
  
  METHODS
  We analyzed patient experience 8 to 12 months and 21 to 24 months after CPC began, measured using 6 domains of the Consumer Assessment of Healthcare Providers and Systems Clinician and Group 12-Month Survey with Patient-Centered Medical Home supplemental items. We compared changes over time in patients giving the best responses between CPC and comparison practices using a regression-adjusted difference-in-differences analysis.
  
  
  RESULTS
  Patient ratings of care over time were generally comparable for CPC and comparison practices, with slightly more favorable differences-generally of small magnitude-for CPC practices than expected by chance. There were small, statistically significant, favorable effects for 2 of 6 composite measures measured using both the proportion giving the best responses and mean responses: getting timely appointments, care, and information; providers support patients in taking care of their own health; and providers discuss medication decisions. There was an additional small favorable effect on the proportion of patients giving the best response in getting timely appointments, care, and information; there was no effect on the mean.
  
  
  CONCLUSIONS
  During the first 2 years of CPC, CPC practices showed slightly better year-to-year patient experience ratings for selected items, indicating that transformation did not negatively affect patient experience and improved some aspects slightly. Patient ratings for the 2 groups were generally comparable, and both faced substantial room for improvement.
authors.affiliation: Mathematica Policy Research, PO Box 2393, Princeton, NJ 08543. E-mail: KSwankoski@mathematica-mpr.com.
authors.forename: Kaylyn E
authors.initials: KE
authors.lastname: Swankoski
authors.forename: Deborah N
authors.initials: DN
authors.lastname: Peikes
authors.forename: Stacy B
authors.initials: SB
authors.lastname: Dale
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Clusen
authors.forename: Nikkilyn
authors.initials: N
authors.lastname: Morrison
authors.forename: John J
authors.initials: JJ
authors.lastname: Holland
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Day
authors.forename: Randall S
authors.initials: RS
authors.lastname: Brown
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003657:Decision Making; D018588:Fee-for-Service Plans; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D006278:Medicare; D009936:Organizational Innovation; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000458:organization & administration*; D016730:Program Development; D011446:Prospective Studies; D014481:United States