To explore perceptions of high-risk patients and their practice staff on the patient-centered medical home, we conducted a multisite qualitative study with chronically ill, low-income patients and their primary care practice staff (N = 51). There were 3 key findings. Both patients and staff described a trade-off: timely care from an unfamiliar provider versus delayed access to their personal physician. Staff were enthusiastic about enhancing access through strategies such as online communication, yet high-risk patients viewed these as access barriers. Practices lacked capacity to manage high-risk patients and therefore frequently referred them to the emergency room.
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Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (Drs Kangovi, Long, and Grande); Penn Center for Community Health Workers, Philadelphia, Pennsylvania (Dr Kangovi and Mr Chanton); Spectrum Health Services, Inc, Philadelphia, Pennsylvania (Dr Kangovi); Philadelphia VA Center for Health Equities Research and Promotion, Philadelphia, Pennsylvania (Drs Kangovi and Long); University of Pennsylvania, Mixed Methods Research Laboratory, Philadelphia (Mss Kellom and Carter); Department of Medicine, University of San Francisco, San Francisco, California (Dr Sha); Leonard Davis Institute of Health Economics. University of Pennsylvania, Philadelphia (Dr Grande); and Department of Internal Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Johnson).
Correspondence: Shreya Kangovi, MD, Department of Medicine, University of Pennsylvania Perelman School of Medicine, 1233 Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104 (firstname.lastname@example.org).
The study was funded by grants from the University of Pennsylvania Center for Therapeutic Effectiveness Research and the Leonard Davis Institute for Health Economics.
The authors have no conflicts of interest to declare.
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