The Association of Patient-centered Medical Home Designation With Quality of Care of HRSA-funded Health Centers: A Longitudinal Analysis of 2012-2015
The Association of Patient-centered Medical Home Designation With Quality of Care of HRSA-funded Health Centers: A Longitudinal Analysis of 2012-2015
复制标题
DOI：
10.1097/mlr.0000000000000862
复制
发表时间：
2018-02-01
期刊：
影响因子：
3
通讯作者：
Lee, De-Chih
中科院分区：
文献类型：
--
作者：
Hu, Ruwei;Shi, Leiyu;Lee, De-Chih
目的：(1)评估以患者为中心的医疗之家（PCMH）认可与医疗中心临床护理质量之间的关系；(2)确定认可的持续时间是否与累积质量改善呈正相关。方法：数据来源于2012 - 2015年统一数据系统、卫生中心的PCMH识别情况和区域资源文件。卫生中心为观察单位。结果变量包括11项临床质量指标。我们汇总了所有年份的数据，并使用广义估计方程对纵向数据进行建模，以检查2012-2015年间获得和未获得PCMH认可的医疗中心的医疗质量改善程度。结果：在研究的所有年份中，具有PCMH识别的卫生中心在临床质量测量方面的表现通常优于未具有PCMH识别的卫生中心。在考虑了卫生中心和县一级潜在的混杂因素后，较长时间的PCMH认可的卫生中心比较短时间的PCMH认可的卫生中心更有可能在11项措施中的9项上提高其临床质量。结论：卫生中心认可PCMH的时间长度与附加性质量改善呈正相关。采用公私合营医院的护理模式可作为提高初级保健服务质量的一项战略。
Objectives:(1) To evaluate the relationship between Patient-centered Medical Home (PCMH) recognition and quality of clinical care among health centers, and (2) to determine whether the duration of recognition is positively associated with cumulative quality improvement over time.Methods:Data came from the 2012 to 2015 Uniform Data System, health centers' PCMH recognition status, and the Area Resource File. Health center was the unit of observation. The outcome variables included 11 measures of clinical quality. We pooled all years of data and modeled longitudinal data with generalized estimating equations to examine the degree of improvement in health care quality in health centers with and without PCMH recognition over the years 2012-2015.Results:Health centers with PCMH recognition generally performed better on clinical quality measures than health centers that did not have PCMH recognition for all years studied. After accounting for health center and county-level potential confounders, health centers with longer periods of PCMH recognition were more likely to have improved their clinical quality on 9 of 11 measures, than health centers with fewer years of PCMH recognition.Conclusions:Health centers' length of time with PCMH recognition was positively associated with additive quality improvement. Adoption of the PCMH model of care may serve as a strategy to enhance quality of primary care services.