Assessing the relationship between adoption of the patient-centered medical home model and clinical quality in Missouri's federally qualified health centers

Abstract

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT AUTHOR'S REQUEST.] The patient-centered medical home (PCMH) model has become the standard model for primary care clinics, particularly federally qualified health centers (FQHCs), in the United States. Between 2011 and 2014, the majority of Missouri's FQHCs became patient-centered medical homes by completing the National Committee for Quality Assurance's medical home accreditation process. Broad claims of increased clinical quality and cost savings are closely associated with PCMH adoption. The academic literature contains studies that both support and refute this claim. The purpose of this study is to test the hypotheses that (1) Missouri FQHC sites that have implemented the PCMH model will perform better on clinical quality measures than those sites that have not implemented the model and (2) that Missouri's urban FQHC sites will perform better on clinical quality measures than their rural Missouri counterparts. Data were collected from a data warehouse retained by the Missouri Primary Care Association for 31 rural and 11 urban FQHC sites in Missouri. These data were collected on three clinical quality measures, diabetes management (NQF 0575), control of high blood pressure (NQF 0018), and tobacco use assessment (NQF 0028a) for all case and control sites. Results showed a modest but statistically significant difference in clinical quality measure performance for only one (control of high blood pressure) measure. Performance on the selected clinical quality measures was not significantly different between urban and rural sites. Further research is needed to determine which characteristics of the PCMH model add value to clinical performance.