Readiness of primary care practices for medical home certification.

Objectives: To assess the prevalence of medical home infrastructure among primary care practices for children and identify practice characteristics associated with medical home infrastructure.

Methods: Cross-sectional analysis of restricted data files from 2007 and 2008 of the National Ambulatory Medical Care Survey. We mapped survey items to the 2011 National Committee on Quality Assurance's Patient-Centered Medical home standards. Points were awarded for each "passed" element based on National Committee for Quality Assurance scoring, and we then calculated the percentage of the total possible points met for each practice. We used multivariate linear regression to assess associations between practice characteristics and the percentage of medical home infrastructure points attained.

Results: On average, pediatric practices attained 38% (95% confidence interval 34%-41%) of medical home infrastructure points, and family/general practices attained 36% (95% confidence interval 33%-38%). Practices scored higher on medical home elements related to direct patient care (eg, providing comprehensive health assessments) and lower in areas highly dependent on health information technology (eg, computerized prescriptions, test ordering, laboratory result viewing, or quality of care measurement and reporting). In multivariate analyses, smaller practice size was significantly associated with lower infrastructure scores. Practice ownership, urban versus rural location, and proportion of visits covered by public insurers were not consistently associated with a practice's infrastructure score.

Conclusions: Medical home programs need effective approaches to support practice transformation in the small practices that provide the vast majority of the primary care for children in the United States.