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

doi:10.1007/s11606-020-05729-x

. 2020 Aug;35(8):2304-2313.

doi: 10.1007/s11606-020-05729-x. Epub 2020 Feb 24.

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

Karen E Swietek^{1

2}, Bradley N Gaynes³, George L Jackson^{4

5

6}, Morris Weinberger⁷, Marisa Elena Domino^{7

8}

Affiliations

¹ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. swietek-karen@norc.org.
² NORC at the University of Chicago, Chicago, IL, USA. swietek-karen@norc.org.
³ Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC, USA.
⁴ Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care System, Durham, NC, USA.
⁵ Department of Population Health Sciences, Duke University, Durham, NC, USA.
⁶ Division of General Internal Medicine, Duke University, Durham, NC, USA.
⁷ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁸ Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC, USA.

PMID: 32096075
PMCID: PMC7403275
DOI: 10.1007/s11606-020-05729-x

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

Karen E Swietek et al. J Gen Intern Med. 2020 Aug.

. 2020 Aug;35(8):2304-2313.

doi: 10.1007/s11606-020-05729-x. Epub 2020 Feb 24.

Authors

Karen E Swietek^{1

2}, Bradley N Gaynes³, George L Jackson^{4

5

6}, Morris Weinberger⁷, Marisa Elena Domino^{7

8}

Affiliations

¹ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. swietek-karen@norc.org.
² NORC at the University of Chicago, Chicago, IL, USA. swietek-karen@norc.org.
³ Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC, USA.
⁴ Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care System, Durham, NC, USA.
⁵ Department of Population Health Sciences, Duke University, Durham, NC, USA.
⁶ Division of General Internal Medicine, Duke University, Durham, NC, USA.
⁷ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁸ Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC, USA.

PMID: 32096075
PMCID: PMC7403275
DOI: 10.1007/s11606-020-05729-x

Abstract

Background: Research demonstrates that the patient-centered 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 disease-specific 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 Black-white 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.

Keywords: chronic conditions; patient-centered medical homes; quality of care; racial disparities.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

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References

1. Cabassa LJ, Humensky J, Druss B, et al. Do Race, Ethnicity, and Psychiatric Diagnoses Matter in the Prevalence of Multiple Chronic Medical Conditions? Med Care. 2013;51(6):540–547. doi: 10.1097/MLR.0b013e31828dbb19. - DOI - PMC - PubMed
1. Parekh A, Barton M. The challenge of multiple comorbidity for the us health care system. J Am Med Assoc. 2010;303(13):1303–1304. doi: 10.1001/jama.2010.381. - DOI - PubMed
1. Vogeli C, Shields AE, Lee TA, et al. Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. J Gen Intern Med. 2007;22(Suppl 3):391–395. doi: 10.1007/s11606-007-0322-1. - DOI - PMC - PubMed
1. Druss BG, Zhao L, Cummings JR, Shim RS, Rust GS, Marcus SC. Mental comorbidity and quality of diabetes care under medicaid: A 50-state analysis. Med Care. 2012;50(5):428–433. doi: 10.1097/MLR.0b013e318245a528. - DOI - PMC - PubMed
1. Blount A, Ed D. Integrated Primary Care : Organizing the Evidence By. Fam Syst Heal. 2003;21:121–134. doi: 10.1037/1091-7527.21.2.121. - DOI

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[1] Cabassa LJ, Humensky J, Druss B, et al. Do Race, Ethnicity, and Psychiatric Diagnoses Matter in the Prevalence of Multiple Chronic Medical Conditions? Med Care. 2013;51(6):540–547. doi: 10.1097/MLR.0b013e31828dbb19. - DOI - PMC - PubMed

[2] Cabassa LJ, Humensky J, Druss B, et al. Do Race, Ethnicity, and Psychiatric Diagnoses Matter in the Prevalence of Multiple Chronic Medical Conditions? Med Care. 2013;51(6):540–547. doi: 10.1097/MLR.0b013e31828dbb19. - DOI - PMC - PubMed

[3] Parekh A, Barton M. The challenge of multiple comorbidity for the us health care system. J Am Med Assoc. 2010;303(13):1303–1304. doi: 10.1001/jama.2010.381. - DOI - PubMed

[4] Parekh A, Barton M. The challenge of multiple comorbidity for the us health care system. J Am Med Assoc. 2010;303(13):1303–1304. doi: 10.1001/jama.2010.381. - DOI - PubMed

[5] Vogeli C, Shields AE, Lee TA, et al. Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. J Gen Intern Med. 2007;22(Suppl 3):391–395. doi: 10.1007/s11606-007-0322-1. - DOI - PMC - PubMed

[6] Vogeli C, Shields AE, Lee TA, et al. Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. J Gen Intern Med. 2007;22(Suppl 3):391–395. doi: 10.1007/s11606-007-0322-1. - DOI - PMC - PubMed

[7] Druss BG, Zhao L, Cummings JR, Shim RS, Rust GS, Marcus SC. Mental comorbidity and quality of diabetes care under medicaid: A 50-state analysis. Med Care. 2012;50(5):428–433. doi: 10.1097/MLR.0b013e318245a528. - DOI - PMC - PubMed

[8] Druss BG, Zhao L, Cummings JR, Shim RS, Rust GS, Marcus SC. Mental comorbidity and quality of diabetes care under medicaid: A 50-state analysis. Med Care. 2012;50(5):428–433. doi: 10.1097/MLR.0b013e318245a528. - DOI - PMC - PubMed

[9] Blount A, Ed D. Integrated Primary Care : Organizing the Evidence By. Fam Syst Heal. 2003;21:121–134. doi: 10.1037/1091-7527.21.2.121. - DOI

[10] Blount A, Ed D. Integrated Primary Care : Organizing the Evidence By. Fam Syst Heal. 2003;21:121–134. doi: 10.1037/1091-7527.21.2.121. - DOI

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

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