The comparative impact of different patient-centered medical home domains on satisfaction among individuals living with type II diabetes

摘要

Chronic illnesses like type 2 diabetes are costly and difficult to treat. Patient-centered medical homes (PCMH) have the potential to improve patient satisfaction in this population. However, which domains have the most impact on patient satisfaction has not been established. The aim of this study was to assess the relative strength of association between seven PCMH domains and two measures of satisfaction. Cross-sectional data were used in this observational study collected from a random sample of adults aged 18-89 with type 2 diabetes (n=1301) seen at 4 PCMHs. The Ambulatory Care Experiences Survey instrument was used to assess all measures. Dependent variables included 2 measures of patient satisfaction: overall care and personal doctor. Independent variables included patient perceptions of implementation level of 7 PCMH domains categorized into two dimensions: administrative features of care and physician-patient interactions. Administrative features of care include organizational access, integration of care and office staff helpfulness. Physician-patient interactions include communication, comprehensive knowledge and interpersonal treatment. Analysis was conducted using linear regression. The results reveal all physician-patient interaction PCMH domains were significantly associated with both measures of satisfaction. The relationships for administrative features of care were dependent upon the satisfaction outcome being analyzed. Communication and comprehensive knowledge had the strongest association of all domains. The authors conclude variations in importance of PCMH domains on satisfaction exist. Physician-patient interaction domains are the strongest contributors to patient satisfaction and overall experience. Understanding which PCMH domains have the largest impact can inform physician practice’s efforts to improve outcomes of care.