Racial/ethnic and geographic differences in access to a usual source of care that follows the patient-centered medical home model: Analyses from the Medical Expenditure Panel Survey data

Abstract

This study examined racial and geographic differences in access to a usual source of care (USC) and it further explored these differences among individuals who had a USC that followed the patient-centered medical home (PCMH) model. Using cross-sectional data from the Household Component of the Medical Expenditure Panel Survey (2008-2013), our sample consisted of non-institutionalized US civilians ages 18-85 (n= 146,233; weighted n = 229,487,016). Our analysis included weighted descriptive statistics and weighted logistic regressions. Although 76% of the respondents had a USC, only 11% of them had a USC that followed the PCMH model. Among respondents who had a USC that followed the PCMH model, 80% were White, 13% Black, 5% Asian, and 12% were of Hispanic ethnicity. Across U.S. regions, 88% percent of those who had a USC that followed the PCMH model resided in metropolitan statistical areas (MSAs), 22% resided in the West, 26% in the Northeast, 25% in the Midwest, and 27% in the South. Results from logistic regression analyses indicated that race and ethnicity were not significant predictors of having a USC that followed the PCMH model. Northeastern U.S. residents (OR: 1.30; 95% CI:1.06-1.61) were more likely to have a USC that followed the PCMH model compared with southern residents. In conclusion, only a small percentage of respondents in our sample had a USC with the PCMH model. Further, race and ethnicity were not predictors of having a USC with the PCMH model.

Diabetes Standard of Care Among Individuals Who Have Diabetes With and Without Cognitive Limitation Disabilities

“…These associations were statistically significant as well (see Table 2). Individuals who were confident in caring for their diabetes were also more likely to engage in 1 or more of the 4 diabetes care services; however, statistical significance was only associated with somewhat confident and having at least 1 A1C test (OR = 1.77, P < .01), confident and having a foot (text continues on p. 104) Table 1 Variables, Operational Definitions, and Weighted Tabulations (n (13) 2547 (17) 593 71176 141920 (13) 784 (11) 2309 (14) 198 (12) 1900 (12) Control 1785 (12) 342 4880 (11) 1237 (8) 548 (8) 1543 (9) 135 (8) 1292 (8) Fair, good (27) 3199 (21) 3210 (38) 2009 (25) 4333 (29) 1955 (28) 4343 (27) 454 (29) 4426 (29) High blood pressure…”

“…2987 (20) 2292 (27) 2019 (25) 3215 211924 (28) 3291 (20) 485 31 (12) 2119 (14) 724 9908 (11) 1910 (13) 688 (10) 2116 (13) 192 (12) 1769 (11) Angina (8) 1432 (10) 508 6536 71379 (10) 496 71388 (9) 115 71294 (8) Coronary heart disease diagnosis (18) 3055 (20) 1178 141258 (15) 2929 (19) 1013 (14) 3142 (19) 264 (17) 2755 (18) Heart attack diagnosis (13) 2120 (14) 1032 (12) 1082 (13) 2046 (14) 893 (13) 2217 (14) 174 (11) 6155 (26) 3640 (24) 2486 (29) 2483 (30) 3575 (24) 2123 (30) 3913 (24) 547 (35) 3840…”

“…25,26 In addition, having insurance and a regular doctor are characteristics that are positively associated with engaging in diabetes care service utilization. 27,28 Regional differences in service utilization were also observed as individuals from the Northeast US region had fewer diabetes care services. Also, individuals with certain health conditions such as hypertension were more likely to get their feet checked.…”

“…34,37 Having a usual source of care is also associated with the increased likelihood of receiving services. 16,27 Having learned about diabetes care from an external source of information, such as a primary care provider or from a group class, and individuals who were confident in caring for their diabetes were also more likely to engage in diabetes care services. This is consistent with literature showing that among patients with diabetes in general, Diabetes Self-Management Education programs positively affect diabetes outcomes, A1C control, and complications.…”

“…Did not learn care from source (control) 6070 (26) 4123 (27) 1922 (23) 2314 (28) 3670 (24) 2185 (31) 3751 (23) 594 (37) 3723 (24) Learned (25) 1362 (17) 1813 (24) 3010 (21) 1622 (25) 3162 (20) 281 (19) 3162 (21) Confident 8901 (40) 5731 (40) 3158 (39) 3118 (41) 5671 (39) 2510 (38) 6250 (40) 543 (37) 5861 (39) Very confident 7970 (36) 4488 (32) 3454 (42) 2428 (32) 5452 (38) 2184 (33) 5659 (37) 547 (38) 5607 (37) Region of residence West 4714 (20) 2866 (19) 1832 221689 (21) 2967 (20) 1553 223082 (19) 350 223030 (20) Northeast 3865 (16) 2627 (17) 1225 (14) 1212 (15) 2604…”