Physician Perspectives on the Influence of Medical Home Recognition on Practice Transformation and Care Quality for Children with Special Health Care Needs. APPENDIX A: PHYSICIAN DISCUSSION TOPICS

  1. Practice Characteristics

    • Practice type, size, and ownership.
    • Number of CSHCN served and percentage of total patients.


  2. Perspectives on NCQA-Recognition

    • Physician involvement in the NCQA-recognition process.
    • Primary reasons/motivations for practice to seek NCQA-recognition.
    • Perceptions on whether NCQA-recognition signifies that a practice provides better, or different, care than those without recognition and, if so, how.


  3. Impact of NCQA-Recognition on Practice Transformation

    • Changes in the organization of the practice made to achieve NCQA-recognition.
    • Changes in physician clinical processes made as a result of achieving NCQA-recognition.
    • Changes specifically related to providing care for CSHCN made as a result of achieving NCQA-recognition.
    • Most promising or rewarding outcome of achieving NCQA-recognition.
    • Features of being a PCMH that have not lived up to their promise yet.
    • Downsides of achieving NCQA-recognition.


  4. Impact of NCQA-Recognition on Children's Health Service Use and Outcomes

    • Observed changes in service use among CSHCN related to practice transformation to achieve NCQA-recognition.
    • Observed changes in outcomes for CSHCN related to practice transformation to achieve NCQA-recognition.
    • Observed changes in service use and outcomes for children without special needs.
    • Perceived benefits to parents and families of CSHCN related to NCQA-recognition and receiving care at a PCMH.
    • Factors that may impede practice's and physicians' ability to improve care quality and outcomes even with NCQA-recognition.


  5. Relative Impact of NCQA Standards

    • Discussion of 2008 NCQA PCMH standards and elements handout.
    • Perceptions on relative importance or promise of standards for increasing the quality of care and improving outcomes for CSHCN.
    • Standards missing or underemphasized in 2008 NCQA-recognition process.
    • If interviewee chooses, opportunity for additional comments (free thought).


TABLE A.1. 2008 NCQA Standards and Elements Handout
Standard Definition and Selected Examples
1   Access and Communication The practice provides patient access during and after regular business hours, and communicates with patients effectively.
  • Patients have personal clinicians.
  • Same day appointments, based on triage, are available.
  • Telephone advice lines are available with timely response.
2 Patient Tracking and Registry Functions The practice has readily available, clinically useful information on patients that enables it to treat patients comprehensively and systematically.
  • The practice can generate lists of patients and take action to remind patients or clinicians proactively of services needed.
3 Care Management The practice maintains continuous relationships with patients by implementing evidence-based guidelines and applying them to the identified needs of individual patients over time and with the intensity needed by patients.
  • The practice follows guidelines for screenings, immunizations, risk assessments, and counseling and uses patient reminders for appointments, medication refills, and tests.
4 Patient Self-Management Support The practice works to improve patients' ability to self-manage health by providing educational resources and ongoing assistance and encouragement.
5 Electronic Prescribing The practice seeks to reduce medical errors and improve efficiency by eliminating handwritten prescriptions and by using drug safety checks and cost information when prescribing.
6 Test Tracking The practice works to improve effectiveness of care by using timely information on all tests and results.
  • The practice tracks test orders to ensure results are received, flags abnormal tests, and follows-up.
7 Referral Tracking The practice seeks to improve effectiveness, timeliness and coordination by following through on consultations and referrals.
8 Performance Reporting and Improvement The practice seeks to improve effectiveness, timeliness and other aspects of quality by measuring and reporting performance, comparing itself to national benchmarks, giving physicians regular feedback and taking actions to improve.
9 Advanced Electronic Communication The practice maximizes use of electronic communication to improve timeliness, effectiveness, efficiency and coordination of care. The practice offers patients the use of an interactive website.


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