Patients may not understand all the details encompassed by the phrase "patient-centered medical home (PCMH)," but new research indicates that they do appreciate the quality of care rendered at health centers invested in the PCMH model of care.
The research results were highlighted in a study titled "Effects of Patient-Centered Medical Home Attributes on Patients' Perceptions of Quality in Federally Supported Health Centers" that was published in the November/December 2013 issue of Annals of Family Medicine(annfammed.org).
Researchers set out to examine the relationships between patient perceptions of PCMH attributes and the quality of care received in federally supported health centers across the country. A total of 4,562 patient interviews were conducted between September and December 2009, and 95 percent of those were conducted at health centers when patients were visiting for a health appointment.
Specifically, researchers were interested in patients' opinions about access to care, both in getting to the health center and during the medical visit; patient-centered communication with health care professionals and support staff; patient self-management support for chronic conditions and behavioral risks; and receipt of comprehensive preventive care.
According to the authors, this was the first such study "to examine patient perspectives on PCMH attributes in a safety-net setting."
- Researchers examined the relationships between patient perceptions of patient-centered medical home (PCMH) attributes and the quality of care received in federally supported health centers.
- By a large majority, survey participants reported high-quality care in the PCMH and said they were likely to refer friends and relatives to the health care site.
- PCMH attributes related to access to care and communication were associated with a greater likelihood of patients reporting high-quality care.
After participant responses were tabulated, researchers found that
- 83.5 percent of patients reported excellent or very good overall quality of services,
- 81.3 percent reported excellent or very good quality of physician advice and treatment, and
- 84.3 percent said they were very likely to refer friends and relatives to the health care site.
Furthermore, PCMH attributes related to access to care and communication were associated with a greater likelihood of patients reporting high-quality care.
"These high patient ratings among health centers are especially remarkable given that low-income and uninsured patients across the United States generally rate their care much lower," wrote the authors.
"Clinicians seeking to improve their patients' overall perceptions of health care experiences should focus on improving patients' experiences in getting access to care before and during the visit and on promoting clinician and support staff communication skills," authors concluded.
Takeaway for Family Physicians
Bottom line, what patients who participated in this study valued the most was access to and communication with their physicians and other health care professionals.
"The simplicity of what patients value is surprising," said senior author Quyen Ngo-Metzger, M.D., M.P.H., a general internal medicine physician who serves as the scientific director for the U.S. Preventive Services Task Force. "What patients really like is being able to see their doctor or nurse without having to wait a long time and then having a good communication experience."
That makes sense, she added, because what patients can best judge is the quality of face-to-face interactions with their health care team members rather than the behind-the-scenes work associated with the PCMH model, such as use of electronic health records and practice management activities.
Family physicians should remember that their patients' perception of the quality of their health care revolves around that basic physician-patient relationship, said Ngo-Metzger. "Patients want to talk to their physicians. That's the key, and family physicians are known for their strength in patient communication."
Ngo-Metzger noted that as the PCMH model becomes more widespread, those invested in the model should ensure that an important piece of the quality improvement pie is the patient's view of the quality of care he or she is receiving.
Although not always easy, "It's important to include patient surveys and patient feedback as part of quality improvement," said Ngo-Metzger. She acknowledged that the very things that patients appreciate the most -- such as a quickly returned phone call or a promptly answered email -- may be less valued by administrators and insurers, who too often consider physician time better spent performing a medical procedure.
All elements of the PCMH model of care should be valued in our health care system, said Ngo-Metzger. She added that those who train family physicians would do well "not to forget the basics," even as they squeeze in all the necessary requirements of medical education.
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