Duration of medical home participation and quality of care for patients with chronic conditions

Health Serv Res. 2021 Oct;56 Suppl 1(Suppl 1):1069-1079. doi: 10.1111/1475-6773.13710. Epub 2021 Aug 17.


Objective: To examine whether the length of participation in a patient-centered medical home (PCMH), an evidence-based practice, leads to higher quality care for Medicaid enrollees with multiple co-morbid chronic conditions and major depressive disorder (MDD).

Data sources: This analysis uses a unique data source that links North Carolina Medicaid claims and enrollment data with other administrative data including electronic records of state-funded mental health services, a state psychiatric hospital utilization database, and electronic records from a five-county behavioral health carve-out program.

Study design: This retrospective cohort study uses generalized estimating equations (GEEs) on person-year-level observations to examine the association between the duration of PCMH participation and measures of guideline-concordant care, including the receipt of minimally adequate care for MDD, defined as 6 months of antidepressant use or eight psychotherapy visits each year.

Data collection/extraction methods: Adults with two or more chronic conditions reflected in administrative data, including MDD.

Principal findings: We found a 1.7 percentage point increase in the likelihood of receiving guideline-concordant care at 4 months of PCMH participation, as compared to newly enrolled individuals with a single month of participation (p < 0.05). This effect increased with each additional month of PCMH participation; 12 months of participation was associated with a 19.1 percentage point increase in the likelihood of receiving guideline-concordant care over a single month of participation (p < 0.01).

Conclusions: The PCMH model is associated with higher quality of care for patients with multiple chronic conditions and MDD over time, and these benefits increase the longer a patient is enrolled. Providers and policy makers should consider the positive effect of increased contact with PCMHs when designing and evaluating initiatives to improve care for this population.

Keywords: depression; medical homes; multiple chronic conditions; quality of care.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Depressive Disorder, Major / therapy*
  • Female
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Medicaid / statistics & numerical data*
  • Mental Health Services / statistics & numerical data*
  • Middle Aged
  • Multiple Chronic Conditions / therapy*
  • North Carolina
  • Patient-Centered Care / statistics & numerical data*
  • Quality of Health Care / statistics & numerical data*
  • Retrospective Studies
  • United States