The Patient-Centered Medical Home

Reibling, Nadine

doi:10.1177/1077558715622913

Cited by 10 publications

(8 citation statements)

References 41 publications

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“…Individuals with private insurance, employed, and living in a high-income family were found to report better access to PCMH. These findings are consistent with the literature in that access to PCMH is limited due to financial barriers [ 40 ]. Therefore, policy makers and health care providers should pay special attention to these barriers as they may negatively affect health-related outcomes, and the effect is substantial, especially among individuals with chronic diseases.…”

Section: Discussionsupporting

confidence: 92%

Patient-centered medical home care access among adults with chronic conditions: National Estimates from the medical expenditure panel survey

Almalki

Karami

Almsoudi

et al. 2018

BMC Health Serv Res

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BackgroundThe Patient-Centered Medical Home (PCMH) model is a coordinated-care model that has served as a means to improve several chronic disease outcomes and reduce management costs. However, access to PCMH has not been explored among adults suffering from chronic conditions in the United States. Therefore, the aim of this study was to describe the changes in receiving PCMH among adults suffering from chronic conditions that occurred from 2010 through 2015 and to identify predisposing, enabling, and need factors associated with receiving a PCMH.MethodsA cross-sectional analysis was conducted for adults with chronic conditions, using data from the 2010–2015 Medical Expenditure Panel Surveys (MEPS). Most common chronic conditions in the United States were identified by using the most recent data published by the Agency for Healthcare Research and Quality (AHRQ). The definition established by the AHRQ was used as the basis to determine whether respondents had access to PCMH. Multivariate logistic regression analyses were conducted to detect the association between the different variables and access to PCMH care.ResultsA total of 20,403 patients with chronic conditions were identified, representing 213.7 million U.S. lives. Approximately 19.7% of the patients were categorized as the PCMH group at baseline who met all the PCMH criteria defined in this paper. Overall, the percentage of adults with chronic conditions who received a PCMH decreased from 22.3% in 2010 to 17.8% in 2015. The multivariate analyses revealed that several subgroups, including individuals aged 66 and older, separated, insured by public insurance or uninsured, from low-income families, residing in the South or the West, and with poor health, were less likely to have access to PCMH.ConclusionOur findings showed strong insufficiencies in access to a PCMH between 2010 and 2015, potentially driven by many factors. Thus, more resources and efforts need to be devoted to reducing the barriers to PCMH care which may improve the overall health of Americans with chronic conditions.

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Section: Discussionsupporting

confidence: 92%

Patient-centered medical home care access among adults with chronic conditions: National Estimates from the medical expenditure panel survey

Almalki

Karami

Almsoudi

et al. 2018

BMC Health Serv Res

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“…(44) Our study may also shed some light on prior work that found that PCMH did not appear to reduce disparities in care quality in both pediatric and adult populations. (45, 46) Our results echo the sentiment that a “one size fits all” approach to primary care redesign may not be the answer to improving patient experiences. Organizational processes related may benefit from targeted approaches that encompass culturally sensitive training for the practice team and front line staff.…”

Section: Discussionsupporting

confidence: 69%

Organizational Processes and Patient Experiences in the Patient-centered Medical Home

Aysola¹,

Schapira

Huo³

et al. 2018

Medical Care

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“…Evidence about the effects of the PCMH in vulnerable populations is limited, and studies of racial disparities in quality in PCMH initiatives report mixed results. 13,[22][23][24] One study found the PCMH reduced or eliminated racial disparities in preventive care reminders, cholesterol testing, and cancer screenings; 25 others observed varying effects among racial/ethnic groups, 19,[26][27][28] with some finding no effect. 29 Because the PCMH is being widely adopted in Medicaid, assessing its potential to reduce disparities has significant policy implications.…”

mentioning

confidence: 99%

Effect of the Patient-Centered Medical Home on Racial Disparities in Quality of Care

et al. 2020

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BACKGROUND: Research demonstrates that the patientcentered medical home (PCMH) is associated with improved clinical outcomes and quality of care, and the populations that can most benefit from this model require long-term management, e.g., persons with chronic illness and behavioral health conditions. However, different populations may not benefit equally from the PCMH, and empirical evidence about the effects of this model on racial disparities is limited. OBJECTIVE: Estimate the association between enrollment in National Committee for Quality Assurance (NCQA)-recognized PCMHs and racial disparities in quality of care for adults with major depressive disorder (MDD) and comorbid medical conditions. DESIGN: Applying a quasi-experimental instrumental variable design to account for differential selection into the PCMH, we used generalized estimating equations to determine the probability of receiving eight diseasespecific quality measures. SUBJECTS: Medicaid enrollees in three states not dually enrolled in Medicare, ages 18-64 with MDD and > 1 other chronic condition. A subgroup analysis was conducted for enrollees with comorbid diabetes. INTERVENTIONS: Enrollment in an NCQA-recognized PCMH. MAIN MEASURES: Disease-specific quality indicators for MDD (e.g., antidepressant use, receipt of psychotherapy), and for diabetes, (e.g. A1c testing, LDL-C testing, retinal exams, and medical attention for nephropathy). KEY RESULTS: PCMH enrollment was associated with an increase in the overall likelihood of receiving six of eight recommended services and a decrease in the likelihood of receiving any psychotherapy (4.94 percentage points, p < 0.01) and retinal exams (5.51 percentage points, p < 0.05). Although both groups improved, PCMH enrollment was associated with an exacerbation of the Blackwhite disparity in adequate antidepressant use by 4.20 percentage points (p < 0.01). CONCLUSIONS: While PCMH enrollment may improve the overall quality of care, the effect is inconsistent across racial groups and not always associated with reductions in racial disparities in quality.

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The Patient-Centered Medical Home

Cited by 10 publications

References 41 publications

Patient-centered medical home care access among adults with chronic conditions: National Estimates from the medical expenditure panel survey

Patient-centered medical home care access among adults with chronic conditions: National Estimates from the medical expenditure panel survey

Organizational Processes and Patient Experiences in the Patient-centered Medical Home

Effect of the Patient-Centered Medical Home on Racial Disparities in Quality of Care

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