Tool that assesses home care has a flaw?
The assessment tool used by federal government programs to measure whether a community health center is functioning as a "medical home" was developed by the nonprofit National Committee for Quality Assurance (NCQA). But, according to a new University of California, Los Angeles (UCLA) study published in the journal Health Affairs, there's a problem: The NCQA tool doesn't adequately evaluate the services that determine the quality of diabetes care in community health centers.1 In fact, the study found, there is no relation between how well a health center scored on the NCQA assessment and the quality of diabetes care it provided.
"The major issue here is that the NCQA assessment tool was developed based on evidence of what worked for private primary-care practices that delivered care to insured patients," said lead author Robin Clarke, MD, a physician in the Robert Wood Johnson Foundation Clinical Scholars program in the Division of General Internal Medicine and Health Services Research at the David Geffen School of Medicine at UCLA. "Because we have limited experience in applying the NCQA tool to community health centers, there is a question of what effective, patient-centered care for low-income patients actually entails."
For their study, the researchers had 30 Los Angeles County community health centers complete the 2008 NCQA Physician Practice Connections/Patient-Centered Medical Home (PPC-PCMH) tool, which assesses the operational systems the health centers use to identify, track, and treat their patients. Health centers are scored on a 0-to-100 scale and, based on their scores, are given recognition levels ranging from Level 3 on the high end to "not recognized" on the low end.
Of the 30 participating community health centers, eight earned Level 3 recognition on the PPC-PCMH assessment tool, three were at Level 2, and 19 were at Level 1. There was a wide range of NCQA scores on the tool, which indicated that some health centers had many more medical home components than others. There were also substantive differences in the quality of diabetes care within the sample.
"We found that there was a broad distribution of NCQA scores and a broad distribution in the quality of diabetes care that these health centers deliver," Clarke said. "But there was no statistically important relationship in how well a clinic scores on NCQA and the quality of care it provides."
Clarke and his co-investigators write in the study that these federal programs launched by the healthcare reform law represent a special opportunity: a combination of stable insurance through healthcare reform and genuine patient-centered medical home care through a community health center, which could potentially help reduce illness and premature death among low-income diabetes patients. In addition, if these patients receive better primary care, they might be less likely to use emergency departments and require hospital care.
"There is a lot of potential for the positive effects that the patient-centered medical home model could have on community health center care," Clarke said. "But the NCQA's tool itself seems to miss the services that are important for low-income diabetes patients."
Reference
- Clarke R, Tseng C, Brook R, et al. Tool used to assess how well community health centers function as medical homes may be flawed. Health Affairs2012; 31: doi: 10.1377/hlthaff.2011.0908.
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