Associations between the patient-centered medical home and preventive care and healthcare quality for non-elderly adults with mental illness: A surveillance study analysis

Abstract

BackgroundPatient-centered medical homes (PCMHs) may improve outcomes for non-elderly adults with mental illness, but the extent to which PCMHs are associated with preventive care and healthcare quality for this population is largely unknown. Our study addresses this gap by assessing the associations between receipt of care consistent with the PCMH and preventive care and healthcare quality for non-elderly adults with mental illness.MethodsThis surveillance study used self-reported data for 6,908 non-elderly adults with mental illness participating in the 2007–2012 Medical Expenditure Panel Survey. Preventive care and healthcare quality measures included: participant rating of all healthcare; cervical, breast, and colorectal cancer screening; current smoking; smoking cessation advice; flu shot; foot exam and eye exam for people with diabetes; and follow-up after emergency room visit for mental illness. Multiple logistic regression models were developed to compare the odds of meeting preventive care and healthcare quality measures for participants without a usual source of care, participants with a non-PCMH usual source of care, and participants who received care consistent with the PCMH.ResultsCompared to participants without a usual source of care, those with a non-PCMH usual source of care had better odds of meeting almost all measures examined, while those who received care consistent with the PCMH had better odds of meeting most measures. Participants who received care consistent with the PCMH had better odds of meeting only one measure compared to participants with a non-PCMH usual source of care.ConclusionsCompared with having a non-PCMH usual source of care, receipt of care consistent with the PCMH does not appear to be associated with most preventive care or healthcare quality measures. These findings raise concerns about the potential value of the PCMH for non-elderly adults with mental illness and suggest that alternative models of primary care are needed to improve outcomes and address disparities for this population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1676-z) contains supplementary material, which is available to authorized users.

Administrative Work and Job Role Beliefs in Primary Care Physicians: An Analysis of Semi-Structured Interviews

“…A recent systematic review reported that PCMHs reduce cost and utilization of PCPs, but that the evidence is still mixed on the effect of PCMHs toward quality and specialist utilization (Jabbapour et al, 2017). Research on the link between PCMHs and patient experience is more limited, but these models have been linked to higher patient satisfaction (Bowdoin et al, 2016;Kottke et al, 2016;Zulman et al, 2017). The relationship between PCMH and physician experience is not well studied, but one analysis of an organizational intervention emphasizing teamwork and team communication demonstrated a link between the intervention and a greater decrease in burnout and a greater increase in job satisfaction (Linzer et al, 2015).…”

The Patient-Centered Care and Receipt of Preventive Services Among Older Adults With Chronic Diseases: A Nationwide Cross-sectional Study

“… 9 , 14 MEPS variables used to assess whether respondents received PCC were selected based on synthesized attributes of PCC, face validity, and similar questions used in previous MEPS published work in operationalizing the PCC. 9 - 11 , 15 - 17 The authors (H.L., L.S., and J.Z.) made initial selections and assignments, and the coauthors (J.A.W., X.K., and M.A.B.)…”

Impact of Medical Homes on Expenditures and Utilization for Beneficiaries With Behavioral Health Conditions

“…There are relatively few studies with which to compare our results. One survey found little evidence that PCMHs had an impact on use of recommended preventive care for adults with mental illness (27); however, other studies have found modest shifts in care for Medicaid enrollees in the PCMH with severe behavioral health conditions or general medical and psychiatric comorbidity (28)(29)(30)(31). The clinicalcondition criteria used to select our Medicaid sample were less restrictive than those in studies that found some positive effects, and thus there may be differential impacts on persons with more severe conditions that are masked when effects within a population of mixed medical complexity are examined.…”