TY - JOUR
KW - Humans
KW - Massachusetts
KW - Patient-Centered Care/organization & administration
KW - Physicians, Family/supply & distribution
KW - Primary Health Care/manpower
KW - Quality Assurance, Health Care/organization & administration
KW - Vulnerable Populations
AU - M. W. Friedberg
AU - K. L. Coltin
AU - D. G. Safran
AU - M. Dresser
AU - E. C. Schneider
A1 - 
AB - BACKGROUND: Under current medical home proposals, primary care practices using specific structural capabilities will receive enhanced payments. Some practices disproportionately serve sociodemographically vulnerable neighborhoods. If these practices lack medical home capabilities, their ineligibility for enhanced payments could worsen disparities in care. METHODS: Via survey, 308 Massachusetts primary care practices reported their use of 13 structural capabilities commonly included in medical home proposals. Using geocoded US Census data, we constructed racial/ethnic minority and economic disadvantage indices to describe the neighborhood served by each practice. We compared the structural capabilities of "disproportionate-share" practices (those in the most sociodemographically vulnerable quintile on each index) and others. RESULTS: Racial/ethnic disproportionate-share practices were more likely than others to have staff assisting patient self-management (69% vs 55%; P = .003), on-site language interpreters (54% vs 26%; P < .001), multilingual clinicians (80% vs 51%; P < .001), and multifunctional electronic health records (48% vs 29%; P = .01). Similarly, economic disproportionate-share practices were more likely than others to have physician awareness of patient experience ratings (73% vs 65%; P = .03), on-site language interpreters (56% vs 25%; P < .001), multilingual clinicians (78% vs 51%; P < .001), and multifunctional electronic health records (40% vs 31%; P = .03). Disproportionate-share practices were larger than others. After adjustment for practice size, only language capabilities continued to have statistically significant relationships with disproportionate-share status. CONCLUSIONS: Contrary to expectations, primary care practices serving sociodemographically vulnerable neighborhoods were more likely than other practices to have structural capabilities commonly included in medical home proposals. Payments tied to these capabilities may aid practices serving vulnerable populations.
BT - Archives of Internal Medicine
C5 - Education & Workforce; Financing & Sustainability; Medical Home; HIT & Telehealth
CP - 11
CY - United States
DO - 10.1001/archinternmed.2010.110
IS - 11
JF - Archives of Internal Medicine
N2 - BACKGROUND: Under current medical home proposals, primary care practices using specific structural capabilities will receive enhanced payments. Some practices disproportionately serve sociodemographically vulnerable neighborhoods. If these practices lack medical home capabilities, their ineligibility for enhanced payments could worsen disparities in care. METHODS: Via survey, 308 Massachusetts primary care practices reported their use of 13 structural capabilities commonly included in medical home proposals. Using geocoded US Census data, we constructed racial/ethnic minority and economic disadvantage indices to describe the neighborhood served by each practice. We compared the structural capabilities of "disproportionate-share" practices (those in the most sociodemographically vulnerable quintile on each index) and others. RESULTS: Racial/ethnic disproportionate-share practices were more likely than others to have staff assisting patient self-management (69% vs 55%; P = .003), on-site language interpreters (54% vs 26%; P < .001), multilingual clinicians (80% vs 51%; P < .001), and multifunctional electronic health records (48% vs 29%; P = .01). Similarly, economic disproportionate-share practices were more likely than others to have physician awareness of patient experience ratings (73% vs 65%; P = .03), on-site language interpreters (56% vs 25%; P < .001), multilingual clinicians (78% vs 51%; P < .001), and multifunctional electronic health records (40% vs 31%; P = .03). Disproportionate-share practices were larger than others. After adjustment for practice size, only language capabilities continued to have statistically significant relationships with disproportionate-share status. CONCLUSIONS: Contrary to expectations, primary care practices serving sociodemographically vulnerable neighborhoods were more likely than other practices to have structural capabilities commonly included in medical home proposals. Payments tied to these capabilities may aid practices serving vulnerable populations.
PP - United States
PY - 2010
SN - 1538-3679; 0003-9926
SP - 938
EP - 944
EP - 
T1 - Medical home capabilities of primary care practices that serve sociodemographically vulnerable neighborhoods
T2 - Archives of Internal Medicine
TI - Medical home capabilities of primary care practices that serve sociodemographically vulnerable neighborhoods
U1 - Education & Workforce; Financing & Sustainability; Medical Home; HIT & Telehealth
U2 - 20548005
U3 - 10.1001/archinternmed.2010.110
VL - 170
VO - 1538-3679; 0003-9926
Y1 - 2010
ER -