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Abstract

This study investigates whether patient-reported characteristics of the medical home are associated with improved quality and equity of preventive care, advice on health habits, and emergency department use. We used adjusted risk ratios to examine the association between medical home characteristics and care measures based on the 2010 Medical Expenditure Panel Survey. Medical home characteristics are associated with 6 of the 11 outcome measures, including flu shots, smoking advice, exercise advice, nutrition advice, all advice, and emergency department visits. Educational and income groups benefit relatively equally from medical home characteristics. However, compared with insurance and access to a provider, medical home characteristics have little influence on overall disparities in care. In sum, our findings support that medical home characteristics can improve quality and reduce emergency visits but we find no evidence that medical home characteristics alleviate disparities in care.

Keywords

disparities health care utilization primary care patient-centered medical home

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References

Agency for Healthcare Research and Quality. (2012). The patient-centered medical home: Closing the quality gap: Revisiting the state of the science. Retrieved from http://www.effectivehealthcare.ahrq.gov/ehc/products/391/1178/EvidReport208_CQGPatientCenteredMedicalHome_FinalReport_20120703.pdf

Agency for Healthcare Research and Quality. (2015). Medical Expenditure Panel Survey Home. Retrieved from http://meps.ahrq.gov/mepsweb/

American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, & American Osteopathic Association. (2007). Joint principles of the patient-centered medical home. Retrieved from http://www.aafp.org/dam/AAFP/documents/practice_management/pcmh/initiatives/PCMHJoint.pdf

Andersen

R. M.

(1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1-10.

Aysola

Bitton

Zaslavsky

A. M.

Ayanian

J. Z.

(2013). Quality and equity of primary care with patient-centered medical homes. Medical Care, 51, 68-77.

Bates

(2010). Primary care and the US health care system: What needs to change? Journal of General Internal Medicine, 25, 998-999.

Beal

Doty

Hernandez

Shea

Davis

(2007). Closing the divide: How medical homes promote equity in health care: Results from the 2006 Health Quality Survey. Retrieved from http://www.commonwealthfund.org/usr_doc/1035_Beal_closing_divide_medical_homes.pdf?section=4039

Beal

Hernandez

Doty

(2009). Latino access to the patient-centered medical home. Journal of General Internal Medicine, 24(Suppl. 3), 514-520.

BeLue

Degboe

Miranda

Francis

(2012). Do medical homes reduce disparities in receipt of preventive services between children living in immigrant and non-immigrant families? Journal of Immigrant and Minority Health, 14, 617-625.

10.

Berenson

Doty

Abrams

Shih

(2012). Achieving better quality of care for low-income populations: The roles of health insurance and the medical home in reducing health inequities. Commonwealth Fund: Issue Brief, 16, 1-17.

11.

Berenson

R. A.

Hammons

Gans

D. N.

Zuckerman

Merrell

Underwood

W. S.

Williams

A. F.

(2008). A house is not a home: keeping patients at the center of practice redesign. Health Affairs, 27, 1219-1230.

12.

Bindman

A. B.

Grumbach

Osmond

Vranizan

Stewart

A. L.

(1996). Primary care and receipt of preventive services. Journal of General Internal Medicine, 11, 269-276.

13.

Cummings

(2009). The relative merits of risk ratios and odds ratios. Archives of Pediatrics & Adolescent Medicine, 163, 438-445.

14.

DeVoe

J. E.

Tillotson

C. J.

Lesko

S. E.

Wallace

L. S.

Angier

(2011). The case for synergy between a usual source of care and health insurance coverage. Journal of General Internal Medicine, 26, 1059-1066.

15.

DeVoe

J. E.

Tillotson

C. J.

Wallace

L. S.

Lesko

S. E.

Angier

(2012). The effects of health insurance and a usual source of care on a child’s receipt of health care. Journal of Pediatric Health Care, 26, e25-e35.

16.

Diedhiou

Probst

J. C.

Hardin

J. W.

Martin

A. B.

Xirasagar

(2010). Relationship between presence of a reported medical home and emergency department use among children with asthma. Medical Care Research and Review, 67, 450-475.

17.

Epstein

R. M.

Fiscella

Lesser

C. S.

Stange

K. C.

(2010). Why the nation needs a policy push on patient-centered health care. Health Affairs, 29, 1489-1495.

18.

Ferrante

J. M.

Ohman-Strickland

Hahn

K. A.

Hudson

S. V.

Shaw

E. K.

Crosson

J. C.

Crabtree

B. F.

(2008) Self-report versus medical records for assessing cancer-preventive services delivery. Cancer Epidemiology, Biomarkers & Prevention, 17, 2987-2994.

19.

Fiscella

Holt

Meldrum

Franks

(2006). Disparities in preventive procedures: Comparisons of self-report and Medicare claims data. BMC Health Services Research, 6, 122-130.

20.

Flocke

S. A.

Stange

K. C.

Zyzanski

S. J.

(1998). The association of attributes of primary care with the delivery of clinical preventive services. Medical Care, 36, AS21-AS30.

21.

Friedberg

M. W.

Coltin

K. L.

Safran

D. G.

Dresser

Zaslavsky

A. M.

Schneider

E. C.

(2009). Associations between structural capabilities of primary care practices and performance on selected quality measures. Annals of Internal Medicine, 151, 456-463.

22.

Gray

B. M.

Weng

Holmboe

E. S.

(2012). An assessment of patient-based and practice infrastructure-based measures of the patient-centered medical home: Do we need to ask the patient? Health Services Research, 47(1 Pt. 1), 4-21.

23.

Green

A. R.

Tan-McGrory

Cervantes

M. C.

Betancourt

J. R.

(2010). Leveraging quality improvement to achieve equity in health care. Joint Commission Journal on Quality and Patient Safety, 36, 435-442.

24.

Grundy

Hagan

K. R.

Hansen

J. C.

Grumbach

(2010). The multi-stakeholder movement for primary care renewal and reform. Health Affairs, 29, 791-798.

25.

Hearld

L. R.

Alexander

J. A.

(2012). Patient-centered care and emergency department utilization: A path analysis of the mediating effects of care coordination and delays in care. Medical Care Research and Review, 69, 560-580.

26.

Hiatt

Perezstable

Quesenberry

Sabogal

Oterosabogal

Mcphee

(1995). Agreement between self-reported early cancer-detection practices and medical audits among Hispanic and non-Hispanic White health plan members. Preventive Medicine, 24, 278-285.

27.

Hoff

Weller

DePuccio

(2012). The patient-centered medical home: A review of recent research. Medical Care Research and Review, 69, 619-644.

28.

Homer

C. J.

(2009). Health disparities and the primary care medical home: Could it be that simple? Academic Pediatrics, 9, 203-205.

29.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Retrieved from http://www.iom.edu/Reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx

30.

Institute of Medicine. (2002). Unequal treatment: Confronting racial and ethnic disparities in health care. Retrieved from http://www.iom.edu/Reports/2002/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care.aspx

31.

Jackson

G. L.

Powers

B. J.

Chatterjee

Bettger

J. P.

Kemper

A. R.

Hasselblad

Williams

J. W.

(2013). The patient-centered medical home: A systematic review. Annals of Internal Medicine, 158, 169-178.

32.

Kawachi

Daniels

Robinson

D. E.

(2005). Health disparities by race and class: Why both matter. Health Affairs, 24, 343-352.

33.

Kleinman

L. C.

Norton

E. C.

(2009). What’s the risk? A simple approach for estimating adjusted risk measures from nonlinear models including logistic regression. Health Services Research, 44, 288-302.

34.

Mead

Andres

Regenstein

(2014). Underserved patients’ perspectives on patient-centered primary care: Does the patient-centered medical home model meet their needs? Medical Care Research and Review, 71, 61-84.

35.

Millett

Gray

Bottle

Majeed

(2008). Ethnic disparities in blood pressure management in patients with hypertension after the introduction of pay for performance. Annals of Family Medicine, 6, 490-496.

36.

Millett

Netuveli

Saxena

Majeed

(2009). Impact of pay for performance on ethnic disparities in intermediate outcomes for diabetes: A longitudinal study. Diabetes Care, 32, 404-409.

37.

National Committee for Quality Assurance. (2013). NCQA Recognition Directory. Retrieved from http://recognition.ncqa.org/

38.

Norton

Miller

Kleinman

(2013). Computing adjusted risk ratios and risk differences in Stata. Stata Journal, 13, 492-509.

39.

Olomu

A. B.

Grzybowski

Ramanath

V. S.

Rogers

A. M.

Vautaw

B. M.

Chen

Eagle

K. A.

(2010). Evidence of disparity in the application of quality improvement efforts for the treatment of acute myocardial infarction: The American College of Cardiology’s Guidelines Applied in Practice Initiative in Michigan. American Heart Journal, 159, 377-384.

40.

Peikes

Zutshi

Genevro

J. L.

Parchman

M. L.

Meyers

D. S.

(2012). Early evaluations of the medical home: Building on a promising start. American Journal of Managed Care, 18, 105-116.

41.

Pitts

S. R.

Carrier

E. R.

Rich

E. C.

Kellermann

A. L.

(2010). Where Americans get acute care: Increasingly, it’s not at their doctor’s office. Health Affairs, 29, 1620-1629.

42.

Raphael

J. L.

Guadagnolo

B. A.

Beal

A. C.

Giardino

A. P.

(2009). Racial and ethnic disparities in indicators of a primary care medical home for children. Academic Pediatrics, 9, 221-227.

43.

Rittenhouse

D. R.

Shortell

S. M.

Fisher

E. S.

(2009). Primary care and accountable care: Two essential elements of delivery-system reform. New England Journal of Medicine, 361, 2301-2303.

44.

Roby

D. H.

Pourat

Puritan

M. J.

Grunges

S. M.

Dame

Castillo

Kaminski

G. F.

(2010). Impact of patient-centered medical home assignment on emergency room visits among uninsured patients in a county health system. Medical Care Research and Review, 67, 412-430.

45.

Schillinger

Barton

Karter

Wang

Adler

(2006). Does literacy mediate the relationship between education and health outcomes? A study of a low-income population with diabetes. Public Health Reports, 121, 245-254.

46.

Sehgal

A. R.

(2003). Impact of quality improvement efforts on race and sex disparities in hemodialysis. Journal of the American Medical Association, 289, 996-1000.

47.

Shi

(2000). Type of health insurance and the quality of primary care experience. American Journal of Public Health, 90, 1848-1855.

48.

U.S. Preventive Services Task Force. (2014). Retrieved from http://www.uspreventiveservicestaskforce.org/

49.

Vest

J. R.

Bolin

J. N.

Miller

T. R.

Gamm

L. D.

Siegrist

T. E.

Martinez

L. E.

(2010). Medical homes: “Where you stand on definitions depends on where you sit.” Medical Care Research and Review, 67, 393-411.

50.

Vogel

Shields

A. E.

Lee

T. A.

Gibson

T. B.

Murder

W. D.

Weiss

K. B.

Blumenthal

(2007). Multiple chronic conditions: Prevalence, health consequences, and implications for quality, care management, and costs. Journal of General Internal Medicine, 22(Suppl. 3), 391-395.

51.

K. T.

(2002). Usual source of care in preventive service use: A regular doctor versus a regular site. Health Services Research, 37, 1509-1529.

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