Abstract
Importance: To assess the association between degree of change in medical home transformation and the satisfaction of patients, physicians, and other staff with the experience. Study Design: Cross-sectional surveys of lead physicians and patients. Methods: Lead physicians in the first 108 primary care clinics in Minnesota certified as patient-centered medical homes (PCMHs) were asked about the presence and change over the past 3 years of medical home-related practice systems, as well as the job satisfaction of their physicians and staff. Patients in 54 of these clinics were surveyed using the CG-CAHPS (Clinician-Group Consumer Assessment of Healthcare Providers and Systems) questions about their experience. Key Results: The extent of change in systems over time was significantly correlated with reported positive changes in physician (0.29, P = .002) and staff (0.27, P = .005) job satisfaction, but not with the number of systems. System change was negatively correlated with patient reports of access to care (—0.43, P = .001) but unrelated to their experience with physicians and staff. Conclusions: These results add to a minimal literature on these important topics by suggesting improved physician and staff satisfaction, while highlighting the importance of the amount of change on both their satisfaction and that of patients. There may be a need to be particularly careful that medical home changes do not cause deterioration in patient access. While there is currently a rush to encourage and facilitate the transformation of primary care practices into patient-centered medical homes (PCMHs), surprisingly little is known about the impact of such a change on the experiences and satisfaction of either patients or healthcare personnel. In 2010, Hoff described the foundation for the PCMH as shaky, primarily because so little was known about whether either patients or physicians find it attractive.1 In 2012, he published a systematic review of studies through 2010, finding only a few studies of patient or clinician satisfaction; their results presented a mixed picture.2 The main positive results were from studies in Group Health Puget Sound, atypical because of salaried physicians and a common budget between health plan and medical group.3,4 Evaluation of the 36 diverse family practices in the National Demonstration Project was especially troubling, since after 2 years of work on transformation, patients in these practices reported a worse experience with care than at baseline.5,6 Since then, studies of Canadian or safety-net clinics have found positive results for patient or clinician satisfaction, but not since 2010 has this topic been addressed regarding typical United States practices that are becoming PCMHs.7-9