Does the patient-centered medical home model change staffing and use in community health centers?

摘要

Has staffing changed with the adoption of the patient-centered medical home (PCMH)? The authors compared staffing and use outcomes in 450 community health centers that had adopted a PCMH model between 2007 and 2013 with a matched sample of 243 nonadopters in the 50 states and District of Columbia. They found that adopting a PCMH model was significantly associated with a growth in use of PAs and NPs (0.53 full-time equivalent [FTE], 8.77%); other medical staff (medical assistants, nurse aides, and quality assurance staff, 1.23 FTE, 7.46%); mental health/substance abuse staff (0.73 FTE, 17.63%; P =.005); and enabling service staff (case managers and health educators, 0.36 FTE, 6.14%); but not primary care physicians or nurses. No significant increase was found in the total number of visits per year. However, the visits marginally attributed to PA or NP staff (539 FTE, 0.89%) and mental health/substance abuse staff (353 FTE, 0.59%) signifi cantly increased. These findings suggest that the implementation of PCMH actively reengineers staff composition and this, in turn, results in changes in marginal use by each staff type.(1)