BACKGROUND: Under current medical home proposals, primary care practices using specific structural capabilities will receive enhanced payments. Some practices disproportionately serve sociodemographically vulnerable neighborhoods. If these practices lack medical home capabilities, their ineligibility for enhanced payments could worsen disparities in care. METHODS: Via survey, 308 Massachusetts primary care practices reported their use of 13 structural capabilities commonly included in medical home proposals. Using geocoded US Census data, we constructed racial/ethnic minority and economic disadvantage indices to describe the neighborhood served by each practice. We compared the structural capabilities of "disproportionate-share" practices (those in the most sociodemographically vulnerable quintile on each index) and others. RESULTS: Racial/ethnic disproportionate-share practices were more likely than others to have staff assisting patient self-management (69% vs 55%; P = .003), on-site language interpreters (54% vs 26%; P < .001), multilingual clinicians (80% vs 51%; P < .001), and multifunctional electronic health records (48% vs 29%; P = .01). Similarly, economic disproportionate-share practices were more likely than others to have physician awareness of patient experience ratings (73% vs 65%; P = .03), on-site language interpreters (56% vs 25%; P < .001), multilingual clinicians (78% vs 51%; P < .001), and multifunctional electronic health records (40% vs 31%; P = .03). Disproportionate-share practices were larger than others. After adjustment for practice size, only language capabilities continued to have statistically significant relationships with disproportionate-share status. CONCLUSIONS: Contrary to expectations, primary care practices serving sociodemographically vulnerable neighborhoods were more likely than other practices to have structural capabilities commonly included in medical home proposals. Payments tied to these capabilities may aid practices serving vulnerable populations.
BACKGROUND: Under current medical home proposals, primary care practices using specific structural capabilities will receive enhanced payments. Some practices disproportionately serve sociodemographically vulnerable neighborhoods. If these practices lack medical home capabilities, their ineligibility for enhanced payments could worsen disparities in care. METHODS: Via survey, 308 Massachusetts primary care practices reported their use of 13 structural capabilities commonly included in medical home proposals. Using geocoded US Census data, we constructed racial/ethnic minority and economic disadvantage indices to describe the neighborhood served by each practice. We compared the structural capabilities of "disproportionate-share" practices (those in the most sociodemographically vulnerable quintile on each index) and others. RESULTS: Racial/ethnic disproportionate-share practices were more likely than others to have staff assisting patient self-management (69% vs 55%; P = .003), on-site language interpreters (54% vs 26%; P < .001), multilingual clinicians (80% vs 51%; P < .001), and multifunctional electronic health records (48% vs 29%; P = .01). Similarly, economic disproportionate-share practices were more likely than others to have physician awareness of patient experience ratings (73% vs 65%; P = .03), on-site language interpreters (56% vs 25%; P < .001), multilingual clinicians (78% vs 51%; P < .001), and multifunctional electronic health records (40% vs 31%; P = .03). Disproportionate-share practices were larger than others. After adjustment for practice size, only language capabilities continued to have statistically significant relationships with disproportionate-share status. CONCLUSIONS: Contrary to expectations, primary care practices serving sociodemographically vulnerable neighborhoods were more likely than other practices to have structural capabilities commonly included in medical home proposals. Payments tied to these capabilities may aid practices serving vulnerable populations.
Authors: Jonathan M Birnberg; Melinda L Drum; Elbert S Huang; Lawrence P Casalino; Sarah E Lewis; Anusha M Vable; Hui Tang; Michael T Quinn; Deborah L Burnet; Thomas Summerfelt; Marshall H Chin Journal: J Gen Intern Med Date: 2011-08-12 Impact factor: 5.128
Authors: Robert A Gabbay; Mark W Friedberg; Michelle Miller-Day; Peter F Cronholm; Alan Adelman; Eric C Schneider Journal: Ann Fam Med Date: 2013 May-Jun Impact factor: 5.166
Authors: Alexander F Pimperl; Hector P Rodriguez; Julie A Schmittdiel; Stephen M Shortell Journal: Health Serv Res Date: 2017-04-06 Impact factor: 3.402
Authors: Sean R McClellan; Lawrence P Casalino; Stephen M Shortell; Diane R Rittenhouse Journal: J Am Med Inform Assoc Date: 2013-02-08 Impact factor: 4.497
Authors: Anna H Chodos; Cyrus Ahalt; Irena Stijacic Cenzer; Janet Myers; Joe Goldenson; Brie A Williams Journal: Am J Public Health Date: 2014-07-17 Impact factor: 9.308
Authors: Lucinda B Leung; Arturo Vargas-Bustamante; Ana E Martinez; Xiao Chen; Hector P Rodriguez Journal: Health Serv Res Date: 2016-10-21 Impact factor: 3.402
Authors: Joseph S Zickafoose; Sarah J Clark; Joseph W Sakshaug; Lena M Chen; John M Hollingsworth Journal: Pediatrics Date: 2013-02-04 Impact factor: 7.124