Impact of Patient-Centered Medical Home Transformation on Providers, Staff, and Quality.

The Patient-Centered Medical Home (PCMH) has become a widely implemented model to transform the delivery of care, but little evidence exists regarding the model's impact on providers, nurses, and staff. This study examined the impact of the PCMH model on (1) provider and staff satisfaction, (2) work-life balance, (3) teamwork, (4) professional experience, (5) patient care factors, and (6) quality outcomes. The authors confidentially surveyed physicians, advanced practice providers (APPs), nurses, care managers, and office staff in 2011 prior to implementation of the PCMH model and in 2016 after implementation at 34 primary care offices providing care to 171,045 patients. A total of 349 pre-PCMH implementation surveys (84% response rate) and 549 follow-up surveys (92% response rate) were received. Implementation of the PCMH model did not result in changes in provider, nurse, and staff responses to composite measures of satisfaction (P = 0.45), work-life balance (P = 0.68), teamwork (P = 0.26), patient care (P = 0.62), or professional experience (P = 0.14). Physicians and APPs experienced a negative, but mostly nonsignificant, change in all composite measures with implementation of the PCMH model. Quality markers improved for diabetes control HbA1c <8 (62.6% to 67.9%; P < 0.001), hypertension control (60.9% to 75.0%; P < 0.001), breast cancer screening (53.9% to 77.4%; P < 0.001), and colorectal cancer screening (43.9% to 70.3%; P < 0.001). Across a large primary care network, implementation of the PCMH model failed to improve overall satisfaction, work-life balance, teamwork, patient care, or professional experience. The model, combined with financial incentives, did result in improvements across multiple patient quality domains.

Online solicitation offenders are different from child pornography offenders and lower risk contact sexual offenders.

The current study compared 38 lower risk (based on actuarial risk assessments) men convicted of contact sexual offenses against children, 38 child pornography offenders, and 70 solicitation offenders (also known as luring or traveler offenders). Solicitation and child pornography offenders were better educated than contact offenders but did not differ on other sociodemographic variables. In comparison to child pornography offenders, solicitation offenders had lower capacity for relationship stability and lower levels of sex drive/preoccupation and deviant sexual preference. Solicitation offenders were also more problematic than lower risk contact offenders on sex drive/preoccupation and capacity for relationship stability and had greater self-reported use of child pornography. Differences between groups on two actuarial risk measures, the Static-99 and the VASOR, were inconsistent. This study suggests that solicitation offenders differ in meaningful ways from lower risk contact offenders and child pornography offenders and, consequently, in risk, treatment, and supervision needs.