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Patient Experience of Chronic Illness Care and Medical Home Transformation in Safety Net Clinics

Objective: To examine the relationship between medical home transformation and patient experience of chronic illness care.

Study Setting: Thirteen safety net clinics located in five states enrolled in the Safety Net Medical Home Initiative.

Study Design: Repeated cross-sectional surveys of randomly selected adult patients were completed at baseline (n = 303) and postintervention (n = 271).

Data Collection Methods: Questions from the Patient Assessment of Chronic Illness Care (PACIC) (100-point scale) were used to capture patient experience of chronic illness care. Generalized estimating equation methods were used to (i) estimate how differential improvement in patient-centered medical home (PCMH) capability affected differences in modified PACIC scores between baseline and postintervention, and (ii) to examine cross-sectional associations between PCMH capability and modified PACIC scores for patients at completion of the intervention.

Principal Findings: In adjusted analyses, high PCMH improvement (above median) was only marginally associated with a larger increase in total modified PACIC score (adjusted β = 7.7, 95 percent confidence interval [CI]: −1.1 to 16.5). At completion of the intervention, a 10-point higher PCMH capability score was associated with an 8.9-point higher total modified PACIC score (95 percent CI: 3.1–14.7) and higher scores in four of five subdomains (patient activation, delivery system design, contextual care, and follow-up/coordination).

Conclusions: We report that sustained, 5-year medical home transformation may be associated with modest improvement in patient experience of chronic illness care for vulnerable populations in safety net clinics.


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