Patient-centered Medical Homes and Access to Services for New Primary Care Patients

Med Care. 2015 Oct;53(10):857-62. doi: 10.1097/MLR.0000000000000412.


Background: Recent efforts to revitalize primary care have centered on the patient-centered medical home (PCMH). Although enhanced access is an integral component of the PCMH model, the effect of PCMHs on access to primary care services is understudied.

Objective: To determine whether PCMH practices are associated with better access to new appointments for nonelderly adults by direct measurement.

Research design: We estimated the relationship between practice PCMH status and access to care in multivariate regression models, adjusting for a robust set of patient, practice, and geographic characteristics; using data on 11,347 simulated patient calls to 7266 primary care practices across 10 US states merged with data on PCMH practices.

Participants: Trained field staff posing as patients (age younger than 65 y) seeking a new primary care appointment with varying insurance status (private, Medicaid, or self-pay).

Measures: Our primary predictor was practice PCMH status and our primary outcome was the ability of simulated patients to schedule a new appointment. Secondary outcomes included the number of days to that appointment; availability of after-hour appointments; and an appointment with an ongoing primary care provider.

Results: Of the 7266 practices contacted for an appointment, 397 (5.5%) were National Committee for Quality Assurance-recognized PCMHs. In adjusted analyses, callers to PCMH practices compared with non-PCMH practices were more likely to schedule a new appointment (adjusted odds ratio=1.26 (95% CI, 1.01-1.58); P=0.04] and be offered after-hour appointments [adjusted odds ratio=1.36 (95% CI, 1.04-1.75); P=0.02].

Discussion: PCMH practices maybe associated with better access to new primary care appointments for nonelderly adults, those most likely to gain insurance under the Affordable Care Act.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Age Factors
  • Appointments and Schedules
  • Female
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Insurance Coverage / statistics & numerical data
  • Insurance, Health / statistics & numerical data
  • Male
  • Middle Aged
  • Patient-Centered Care / statistics & numerical data
  • Primary Health Care / statistics & numerical data*
  • Residence Characteristics / statistics & numerical data
  • Sex Factors
  • Socioeconomic Factors
  • United States