Graduation Date

Summer 8-18-2017

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Health Services Research, Administration, and Policy

First Advisor

Li-Wu Chen

Abstract

The patient-centered medical home (PCMH) is promoted as a primary care delivery design that can improve health care quality and patient outcomes while controlling health care costs. To achieve PCMH recognition, primary care providers must implement practice-level changes in order to deliver care that is comprehensive, coordinated, accessible, high quality, and whole-person oriented. This practice transformation requires advanced use of health information technology, staff investment in quality improvement and care coordination, and significant investments of both financial and human resources to support these activities. As a safety-net provider, school-based health centers (SBHCs) serve vulnerable children that typically experience barriers to having a medical home. It is critical for SBHCs to keep pace with delivery reform so that the health care disparities seen in children served by SBHCs are not exacerbated. However, characteristics of SBHCs such as their limited finances and small staff size could restrict their ability to implement expensive care delivery changes.

The purpose of this research is to apply organization behavioral theories and adoption of innovation theory to understand the factors associated with adoption of individual PCMH attributes, higher levels of PCMH capacity, and formal recognition as a PCMH in SBHCs. This research addressed the extent to which resource dependency theory and institutional theory can be used to explain PCMH adoption in SBHCs. The first study involved mapping PCMH attributes available in a SBHC national-level secondary data source to recognized PCMH definitions. These attributes underwent factor analysis to create an index that could measure SBHC PCMH capacity. The second study examined the associations between various measures of PCMH capacity and individual PCMH attributes with measures of the SBHC’s internal munificence, environmental complexity, and external isomorphic pressures. The third study examined the associations between formal PCMH recognition and the measures of the SBHC’s internal munificence, environmental complexity, and external isomorphic pressures. The results of these three studies were synthesized to describe how both the SBHC’s internal and external environmental characteristics are associated with various aspects of the overall PCMH adoption process.

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