Key attributes of patient centered medical homes associated with patient activation of diabetes patients

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  • Bilello, Lori A
    • Other Affiliation: Center for Health Equity and Quality Research, College of Medicine, UF Health Jacksonville, 6th Floor, Tower II, Suite 6015, 580 West 8th Street, T60, Jacksonville, FL 32209, USA
  • Hall, Allyson
    • Other Affiliation: Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, USA
  • Harman, Jeffrey
    • Other Affiliation: Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL 32306, USA
  • Scuderi, Christopher
    • Other Affiliation: Department of Community Health and Family Medicine, UF Health Family Medicine and Pediatrics – New Berlin, 3122 New Berlin Road, Jacksonville, FL 32226, USA
  • Shah, Nipa
    • Other Affiliation: Department of Community Health and Family Medicine, College of Medicine, UF Health Jacksonville, 3rd Floor, LRC, 653-1 West 8th Street, C257, Jacksonville, FL 32209, USA
  • Mills, Jon C
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Samuels, Shenae
    • Other Affiliation: Department of Health Services Research, Management & Policy, College of Public Health and Health Professions, University of Florida, PO Box 100195, Gainesville, FL 32610, USA
Abstract
  • Abstract Background Approximately 24 million Americans are living with diabetes. Patient activation among individuals with diabetes is critical to successful diabetes management. The Patient Centered Medical Home (PCMH) model holds promise for increasing patient activation in managing their health. However, what is not well understood is the extent to which individual components of the PCMH model, such as the quality of physician-patient interactions and organizational features of care, contribute to patient activation. This study’s objective is to determine the relative importance of the PCMH constructs or domains to patient activation among individuals living with diabetes. Methods This study is a cross-sectional analysis of 1253 primary care patients surveyed with type II diabetes. The dependent variable, patient activation, was assessed using the Patient Activation Measure (PAM). Independent variables included 7 PCMH domains- organizational access, integration of care, comprehensive knowledge, office staff helpfulness, communication, interpersonal treatment and trust. Ordered logistic regression was performed to determine whether each PCMH domain was independently associated with patient activation, followed by a final ordered logistic regression that included all the PCMH domains in a single adjusted model. Results Using the full adjusted model, the odds of patients reporting higher activation scores (PAM) were found to be significant in the domains that represented organizational access (OR 1.56, 95% CI 1.31–1.85) and comprehensive knowledge (OR 1.44, 95% CI 1.13–1.85). Conclusions Many practices have struggled with the challenge to develop fully functional patient-centered medical homes. In an effort to become more patient-centered, this study aimed to address what factors activated diabetic patients to adhere to diabetes management plan. Understanding these factors can help identify PCMH attributes that practices can prioritize and improve upon to assist their patients in improving health outcomes. Trial registration Study was not a clinical trial; therefore it was not registered.
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  • Article
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  • In Copyright
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  • The Author(s).
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  • English
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  • BMC Family Practice. 2018 Jan 05;19(1):4
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  • BioMed Central

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