Association between patient-centered medical home features and satisfaction with family medicine residency training in the US

Patricia (Patty) Carney, Elaine Waller, Eve Dexter, Miguel Marino, Stephanie E. Rosener, Larry A. Green, Geoffrey Jones, J. Drew M Keister, Julie A. Dostal, Samuel M. Jones, M (Patrice) Eiff

Research output: Contribution to journalArticle

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Abstract

BACKGROUND AND OBJECTIVES: Primary care residencies are undergoing dramatic changes because of changing health care systems and evolving demands for updated training models. We examined the relationships between residents’ exposures to patient-centered medical home (PCMH) features in their assigned continuity clinics and their satisfaction with training. METHODS: Longitudinal surveys were collected annually from residents evaluating satisfaction with training using a 5-point Likert-type scale (1=very unsatisfied to 5=very satisfied) from 2007 through 2011, and the presence or absence of PCMH features were collected from 24 continuity clinics during the same time period. Odds ratios on residents’ overall satisfaction were compared according to whether they had no exposure to PCMH features, some exposure (1–2 years), or full exposure (all 3 or more years). RESULTS: Fourteen programs and 690 unique residents provided data to this study. Resident satisfaction with training was highest with full exposure for integrated case management compared to no exposure, which occurred in 2010 (OR=2.85, 95% CI=1.40, 5.80). Resident satisfaction was consistently statistically lower with any or full exposure (versus none) to expanded clinic hours in 2007 and 2009 (eg, OR for some exposure in 2009 was 0.31 95% CI=0.19, 0.51, and OR for full exposure 0.28 95% CI=0.16, 0.49). Resident satisfaction for many electronic health record (EHR)-based features tended to be significantly lower with any exposure (some or full) versus no exposure over the study period. For example, the odds ratio for resident satisfaction was significantly lower with any exposure to electronic health records in continuity practice in 2008, 2009, and 2010 (OR for some exposure in 2008 was 0.36; 95% CI=0.19, 0.70, with comparable results in 2009, 2010). CONCLUSIONS: Resident satisfaction with training was inconsistently correlated with exposure to features of PCMH. No correlation between PCMH exposure and resident satisfaction was sustained over time.

Original languageEnglish (US)
Pages (from-to)784-794
Number of pages11
JournalFamily Medicine
Volume48
Issue number10
StatePublished - Nov 1 2016
Externally publishedYes

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Patient-Centered Care
Internship and Residency
Medicine
Electronic Health Records
Odds Ratio
Case Management
Longitudinal Studies
Primary Health Care
Delivery of Health Care

ASJC Scopus subject areas

  • Family Practice

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Association between patient-centered medical home features and satisfaction with family medicine residency training in the US. / Carney, Patricia (Patty); Waller, Elaine; Dexter, Eve; Marino, Miguel; Rosener, Stephanie E.; Green, Larry A.; Jones, Geoffrey; Keister, J. Drew M; Dostal, Julie A.; Jones, Samuel M.; Eiff, M (Patrice).

In: Family Medicine, Vol. 48, No. 10, 01.11.2016, p. 784-794.

Research output: Contribution to journalArticle

Carney, PP, Waller, E, Dexter, E, Marino, M, Rosener, SE, Green, LA, Jones, G, Keister, JDM, Dostal, JA, Jones, SM & Eiff, MP 2016, 'Association between patient-centered medical home features and satisfaction with family medicine residency training in the US', Family Medicine, vol. 48, no. 10, pp. 784-794.
Carney, Patricia (Patty) ; Waller, Elaine ; Dexter, Eve ; Marino, Miguel ; Rosener, Stephanie E. ; Green, Larry A. ; Jones, Geoffrey ; Keister, J. Drew M ; Dostal, Julie A. ; Jones, Samuel M. ; Eiff, M (Patrice). / Association between patient-centered medical home features and satisfaction with family medicine residency training in the US. In: Family Medicine. 2016 ; Vol. 48, No. 10. pp. 784-794.
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AU - Carney, Patricia (Patty)

AU - Waller, Elaine

AU - Dexter, Eve

AU - Marino, Miguel

AU - Rosener, Stephanie E.

AU - Green, Larry A.

AU - Jones, Geoffrey

AU - Keister, J. Drew M

AU - Dostal, Julie A.

AU - Jones, Samuel M.

AU - Eiff, M (Patrice)

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N2 - BACKGROUND AND OBJECTIVES: Primary care residencies are undergoing dramatic changes because of changing health care systems and evolving demands for updated training models. We examined the relationships between residents’ exposures to patient-centered medical home (PCMH) features in their assigned continuity clinics and their satisfaction with training. METHODS: Longitudinal surveys were collected annually from residents evaluating satisfaction with training using a 5-point Likert-type scale (1=very unsatisfied to 5=very satisfied) from 2007 through 2011, and the presence or absence of PCMH features were collected from 24 continuity clinics during the same time period. Odds ratios on residents’ overall satisfaction were compared according to whether they had no exposure to PCMH features, some exposure (1–2 years), or full exposure (all 3 or more years). RESULTS: Fourteen programs and 690 unique residents provided data to this study. Resident satisfaction with training was highest with full exposure for integrated case management compared to no exposure, which occurred in 2010 (OR=2.85, 95% CI=1.40, 5.80). Resident satisfaction was consistently statistically lower with any or full exposure (versus none) to expanded clinic hours in 2007 and 2009 (eg, OR for some exposure in 2009 was 0.31 95% CI=0.19, 0.51, and OR for full exposure 0.28 95% CI=0.16, 0.49). Resident satisfaction for many electronic health record (EHR)-based features tended to be significantly lower with any exposure (some or full) versus no exposure over the study period. For example, the odds ratio for resident satisfaction was significantly lower with any exposure to electronic health records in continuity practice in 2008, 2009, and 2010 (OR for some exposure in 2008 was 0.36; 95% CI=0.19, 0.70, with comparable results in 2009, 2010). CONCLUSIONS: Resident satisfaction with training was inconsistently correlated with exposure to features of PCMH. No correlation between PCMH exposure and resident satisfaction was sustained over time.

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