THPE629 - Poster Exhibition
Exploring the patient-centered medical home model in Ryan White funded HIV/AIDS clinics in the United States: propensity, progress and promise
S. Beane1, R. Culyba2, M. Demayo3, W. Armstrong4
1Southeast AIDS Training and Education Center, Emory University, Research and Evaluation, Atlanta, United States, 2University of Pittsburgh Medical Center, Grants and Contracts, Pittsburgh, United States, 3Emory University, Atlanta, Georgia, 4Emory University School of Medicine, Atlanta, United States
Background: This study investigated how well U.S. Ryan White (RW) funded clinics, providing HIV/AIDS care, exemplify characteristics of patient-centered medical homes (PCMH). PCMH principals include coordinated, comprehensive, and continuous care with improved health outcome goals. Benefits of PCMH certification to quality and payment take center stage amid the political landscape of health care reform, RW reauthorization, and budget cuts. Saag (2009) highlights alignment of RW multidisciplinary team care with PCMH concepts; however, the extent to which HIV care corresponds with PCMH criteria unintentionally or through certification is not fully understood. To better understand this relationship, we conducted key informant interviews with experts in RW and HIV medicine across the U.S.
Methods: Using a snowball sample, we conducted semi-structured interviews with seven key informants. There were three inclusion criteria: at least 18 years of age, employed at a RW clinic for at least five years, and employed as a medical director. Three researchers independently coded transcripts and identified themes.
Results: Patient populations ranged in size from 1,110 to 5,100 with at least one-third having an AIDS diagnosis. All informants were familiar with and indicated their clinics provide care aligning with most PCMH principles. In fact, several informants indicated their clinics historically provided PCMH care. Barriers to providing PCMH care included difficulty launching electronic medical records, decreased funding, and limited workforce.
Conclusions: Amid implementation of the Affordable Care Act and RW reauthorization, informants expressed concern for the future of high quality care in RW settings. Our study illuminates alignment of RW care with PCMH models. While PCMH certification may have protective benefits for RW clinics, it is administratively burdensome, suggesting a need for resources to assist RW clinics to be recognized for adoption of PCMH characteristics in a context of fiscal uncertainty.
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