For more on SAFTINet please see http://www.ucdenver.edu/academics/colleges/medicalschool/programs/outcomes/COHO/saftinet/Pages/default.aspx Research Objective: Evidence suggests the patient centered medical home (PCMH) model should improve delivery of preventive care services, lower cost, and enhance quality of care. Widespread but varied PCMH implementation offers the opportunity to conduct observational comparative effectiveness research in real-world settings on the impact of specific PCMH functions on clinical outcomes. We examined a series of practice-level characteristics (hypothesized common causes of both PCMH characteristics and clinical outcomes) as possible correlates of PCMH characteristics and confounders of the PCMH- outcomes relationship. Study Design: Self-report practice-level surveys were administered in 51 primary care practices in the Scalable Architecture for Federated Translational Inquiries Network (SAFTINet), Practice leadership completed (1) the SAFTINet Delivery of Coordinated Care Survey (DoCCS), a measure of multiple PCMH domains including team-based care, panel management, and enhanced access; and (2) a survey of general practice characteristics, including organizational features, patient population, provider/staff characteristics, and health information technology infrastructure. We examined variability in DoCCS total and domain scores and correlations between DoCCS scores and select practice characteristics in 47 practices with complete data. Population Studied: Participating practices are primarily federally qualified health centers with electronic health records, representing ~260,000 patients (30% covered by Medicaid), 500 primary care providers, and four safety net healthcare organizations in Colorado and Tennessee. Principal Findings: Total DoCCS scores were moderate to high (M = 3.70, SD = 0.54) on a scale of 1 to 5, with no significant mean differences among the four organizations. Domain scores were as follows: Personal clinician (M = 4.43, SD = 0.59), Team-based care (M = 3.34, SD = 1.43), Access (M = 3.82, SD = 0.53), Patient centeredness (M = 3.77, SD = 0.72), Coordinated/Integrated care (M = 3.82, SD = 0.51), Quality Improvement (M = 3.56, SD = 0.58), Evidence-Based Medicine (M = 3.42, SD = 0.91), Engaged Leadership (M = 3.40, SD = 0.89), and Registries (M = 3.98, SD = 1.04). Characteristics of patient population that were positively related to total score include proportion of Caucasian patients and proportion of patients for whom English is their first language. Domain-specific results will also be presented. Conclusions: Of practices in SAFTINet, there was variability across practices in DoCCS scores, suggesting that the DoCCS can detect variation in PCMH characteristics. Practices caring for more minority and non-English- speakers.

1. PRACTICE-LEVEL CORRELATES OF PATIENT-CENTERED MEDICAL HOME CHARACTERISTICS IN THE
SCALABLE ARCHITECTURE FOR FEDERATED TRANSLATIONAL INQUIRIES NETWORK
Marion R. Sills, MD, MPH, Bethany M. Kwan, PhD, MSPH, Diane Fairclough, DrPH, Brenda Beaty, MSPH, Mika K. Green, BSc, Lisa M. Schilling, MD, MSPH
University of Colorado; Scalable Architecture for Federated Translational Inquiries Network (SAFTINet)
Delivery of Coordinated Care Survey (DoCCS) Domains and Variability of Scores
Domain Example Goal Mean (S.D.) / Median Interquartile Range
Overall Score 3.87 (0.56) / 3.90 3.49 – 4.30
Personal Clinician Clearly link patients to clinician and/or care team 4.49 (0.53) / 4.67 4.17 – 4.92
Team-Based Care Team-based care led by clinician 3.51 (1.31) / 4.00 3.00 – 4.50
Coordinated Care Link patients with community resources to facilitate referrals 3.93 (0.56) / 3.91 3.55 – 4.38
Patient-Centered Care Assess and respect patient values and expressed needs 3.87 (0.75) / 4.00 3.17 – 4.43
QI & Safety Establish/monitor metrics to evaluate QI efforts and provide feedback. 3.73 (0.60) / 3.78 3.40 – 4.22
Evidence-based Medicine Use point of care reminders based on clinical guidelines 3.58 (0.86) / 3.60 3.00 – 4.20
Access Provide scheduling options that are accessible to all patients 4.03 (0.61) / 4.10 3.65 – 4.58
Engaged Leadership Provide visible and sustained leadership 3.61 (0.92) / 3.67 3.00 – 4.33
Background
• Evidence suggests the patient centered medical
home (PCMH) model should improve delivery,
cost and quality of care
• Widespread, varied PCMH implementation
permits comparison of the effectiveness of PCMH
characteristics on improving outcomes
• To account for selection bias in analyses of PCMH
characteristics and outcomes, both patient- and
practice-level factors are potential confounders;
here we focus on potential practice-level
confounders
Objectives
• To measure practice-level characteristics:
• Practice demographic descriptors
• Characteristics consistent with the PCMH
model
• To measure the correlation between practice
demographics and PCMH characteristics
Study Design
• Self-report practice-level surveys administered to
practice leadership in primary care practices in
the Scalable Architecture for Federated
Translational Inquiries Network (SAFTINet)
Methods
Measures
• Baseline Practice Characteristics (BPC) survey
• Organizational features (e.g., ACO membership, provider descriptors)
• Patient population
• Delivery of Coordinated Care Survey (DoCCS)
• Practice-level self-report survey of clinician and staff perceptions of medical home
characteristics
• Mean score for each domain (5-17 items per domain, measured on 1-5 scale,
“No/Almost Never” to “Almost Always”)
• Overall “medical home” score: mean of domain scores
Participants
• All sites in SAFTINet with primary care (N = 47)
• Up to 3 DoCCS per practice: lead clinician/medical director, practice manager, lead member
of nursing staff
• BPC completed by central data person/team and/or practice managers
Timeline
• Completed July to September 2012
Analysis
• Variability in DoCCS total and domain scores
• Selected 2 domains for presentation here: team-based care (because of greatest variability
among practices) and patient-centered care (because domain is of interest in patient-
centered outcomes research)
• Associations between DoCCs scores and practice characteristics
Practice Characteristics and Medical Home (DoCCS) Score
DoCCS Total Mean Score Team-Based Care Mean Score Patient-Centered Care Mean Score
<4
(n=29, 63%)
>4
(n=17, 37%)
P
<4
(n=25, 54%)
>4
(n=21, 46%)
P
<4
(n=23, 63%)
>4
(n=22, 49%)
P
Organizational Characteristics
Belongs to ACO 21 (70%) 9 (30%) 0.18 19 (63%) 11 (37%) 0.09 17 (57%) 13 (43%) 0.29
Number of specialties (internal medicine, pediatrics, family medicine, psychiatry) represented
• 1 specialty 11 (55%) 9 (45%) 0.32 9 (45%) 11 (55%) 0.26 11 (55%) 9 (45%) 0.64
• >1 specialty 18 (69%) 8 (31%) 16 (62%) 10 (38%) 12 (48%) 13 (52%)
Median # visits/week 210 142 0.09 W* 226 128 0.09 W* 226 189 0.41 W*
Median # behavioral health visits/week 7.8 16.7 0.29 W 8.1 16.7 0.29 W 3.5 41.6 0.004 W
Median number of unique patients 5145 2656 0.02 W 5148 2656 0.02 W 5145 3926 0.83 W
Median number of Medical FTE 4.9 3.0 0.08 W 5.3 3.0 0.08 W 4.9 3.3 0.78 W
Median number of Behavioral Health FTE 0.4 1.0 0.46 W 1.0 0.4 0.46 W 0.4 1.2 0.32 W
Patient Population Characteristics
Median % Female 58.1 56.5 0.32 W 59.0 56.3 0.32 W 57.0 56.9 0.56 W
Median % practice <18 years old 34.7 27.3 0.44 W 30.8 32.5 0.44 W 30.6 34.7 0.64 W
Median % Non-white 38.1 24.4 0.08 W 42.2 27.0 0.08 W 35.0 33.8 0.52 W
Median % Hispanic/Latino 34.7 13.0 0.02 W 33.2 13.0 0.02 W 34.0 22.2 0.17 W
Median % Preferred language is English 64.7 84.0 0.01 W 68.0 80.0 0.01 W 68.0 75.8 0.39 W
Insurance
• % Private 5.0 10.8 0.32 W 6.5 7.3 0.32 W 3.0 10.4 0.37 W
• % Medicare 5.4 12.9 0.17 W 5.4 12.0 0.17 W 7.0 7.1 0.98 W
• % Medicaid 37.8 29.0 0.09 W 37.5 33.1 0.09 W 32.7 36.5 0.69 W
• % Self-pay 25.1 19.6 0.43 W 24.3 23.8 0.43 W 26.6 21.1 0.16 W
*W = Wilcoxon test
Conclusions
• Variability across practices in DoCCS scores suggests that the DoCCS can detect variation in PCMH characteristics.
• Practices caring for more patients, and more Hispanic/Latino and non-English-speaking patient populations showed lower DoCCS scores.
• Aspects of the patient population, but not of provider/staff characteristics or organizational structure, may be potential confounders of a PCMH-clinical outcomes
relationship in our observational research.
• These results may only apply to practices similar to those included in this research.
Scalable Architecture for Federated Translational Inquiries Network (SAFTINet) is supported by the Agency for Healthcare Research and Quality (AHRQ R01-HSO19908; Principal Investigator Lisa Schilling, MD, MSPH (lisa.schilling@ucdenver.edu)