A First Look at PCMH Implementation for Minority Veterans Room for Improvement

作者：Hernandez Susan E^*; Taylor Leslie; Grembowski David; Reid Robert J; Wong Edwin; Nelson Karin M; Liu Chuan Fen; Fihn Stephan D; Hebert Paul L

来源：Medical Care, 2016, 54(3): 253-261.

DOI：10.1097/MLR.0000000000000512

• primary care
• health care delivery
• health inequality
• disparities
• patient-centered care
• health disparities
• delivery of health care
• health service research

Background:
Implementation of Patient Aligned Care Teams (PACT), a patient-centered medical home model, has been inconsistent among the > 900 primary care facilities in the Veterans Health Administration.
Objective:
Estimate if the degree of PACT implementation at a facility varied with the percentage of minority veteran patients at the facility.
Research Design:
Cross-sectional, facility-level analysis of PACT implementation measures in 2012.
Subjects:
Veterans Health Administration hospital-based and community-based primary care facilities.
Measures:
We used a previously validated PACT Implementation Progress Index (Pi(2)) and its 8 domains: access, continuity of care, care coordination, comprehensiveness, self-management support, and patient-centered care and communication, shared decision-making domains, and team functioning. Facilities were categorized as low (< 5.2%, n=208), medium (5.2%-25.8%, n=413), and high (> 25.8%, n=206) percent minority based on the percent of their own veteran population.
Results:
Most minority veterans received care in high minority (69%) and medium minority facilities (29%). In adjusted analyses, medium and high minority facilities scored 0.773 (P=0.009) and 0.930 (P=0.008) points lower on the Pi(2) score relative to low minority facilities. Relative to low minority facilities, both medium and high minority facilities were less likely of having high Pi(2) scores (>= 2) and more likely of having low Pi(2) scores (<=-2). Both medium and high minority facilities had the same 3 domain scores lower than low minority facilities (care coordination, comprehensiveness, and self-management).
Conclusion:
Overall PACT implementation varied with respect to the racial/ethnic composition of a facility, with medium and high minority facilities having a lower implementation scores.

• 出版日期2016-3