Assessing Medical Home Readiness Within Health Centers

Federally Qualified Health Centers (FQHCs) serve many of the sickest and poorest Americans. This study developed and validated a scale to assess medical home readiness within health centers and identified relationships between medical home readiness, health center and patient characteristics, and community attributes. Published literature was reviewed to identify the domains and items most crucial to the development of a medical home for inclusion in a readiness scale for health centers. An expert panel was convened to examine the content validity of the scale. Following the development and preliminary validation of the scale, a pilot study was conducted to further test the tool. Finally, the scale was distributed to a national random sample of health centers. Data on health outcomes, organizational characteristics, and community attributes were extracted from additional survey questions, the 2012 Health Resources and Services Administration Uniform Data System, and the 2012-2013 Area Health Resource Files. A total of 12 domains and 45 items were selected to be included in the medical home readiness scale. There was no expert consensus to remove any of the initial scale domains and items. In the pilot study, 16 health centers reported a mean medical home readiness score of 28.8 out of 45 total points. A total of 202 FQHCs completed the national survey. The mean medical home readiness score from the national survey was 31.68. In addition, we found that having outside medical home accreditation was associated with a higher readiness score. Based on the distribution of responses, we identified 31.5 to be the cut-off point in distinguishing health centers who have achieved medical home transformation versus those who have not. In considering relationships between medical home readiness, health center and patient characteristics, and community attributes, increased percentages of minority and hypertensive patients as well as cervical cancer screenings were associated with higher medical home readiness scores. High internal collaboration was also found to be associated with significantly higher medical home scores. Additional research is necessary to further explore these relationships in an effort to allocate resources appropriately within health centers and implement the most suitable regulations for medical home transformation