Using fuzzy set qualitative comparative analysis (fs/QCA) to explore the relationship between medical "homeness" and quality
Nels Marcus Thygeson, Leif I Solberg, Stephen E Asche, Patricia Fontaine, Leonard Gregory Pawlson, Sarah Hudson Scholle, Nels Marcus Thygeson, Leif I Solberg, Stephen E Asche, Patricia Fontaine, Leonard Gregory Pawlson, Sarah Hudson Scholle
Abstract
Objective: Determine, using fuzzy set qualitative comparative analysis (fs/QCA), the relationship between patient-centered medical home (PCMH) systems and quality in 21 NCQA recognized medical homes.
Data sources/study setting: Primary data collected in 2009, including measures of optimal diabetes care (ODC), preventive services up-to-date (PSUTD), patient experience (PEX), survey data assessing PCMH capabilities (PPC-RS), and other clinic characteristics.
Study design: Cross-sectional study identifying associations between PPC-RS domains, demographic, socioeconomic, and co-morbidity measures, and quality outcomes.
Data collection/extraction methods: PPC-RS scores were obtained by surveying clinic leaders. PSUTD and ODC scores were obtained from provider performance data. PEX data were obtained from patient surveys. Demographic, socioeconomic, and co-morbidity data were obtained from EMR and census data.
Principal findings: fs/QCA identified associations between all three outcomes and PCMH capabilities: ODC and team-based care; PSUTD and preventive services systems; and all three outcomes and provider performance reporting systems. Previous statistical analysis of this data had failed to identify these relationships.
Conclusions: fs/QCA identified important associations that were overlooked using conventional statistics in a small-N health services data set. PCMH capabilities are associated with quality outcomes.
© Health Research and Educational Trust.
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Source: PubMed