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

Publication ,  Journal Article
Swietek, KE; Gaynes, BN; Jackson, GL; Weinberger, M; Domino, ME
Published in: J Gen Intern Med
August 2020

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.

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Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

August 2020

Volume

35

Issue

8

Start / End Page

2304 / 2313

Location

United States

Related Subject Headings

  • Young Adult
  • White People
  • United States
  • Quality of Health Care
  • Patient-Centered Care
  • Middle Aged
  • Medicare
  • Medicaid
  • Humans
  • General & Internal Medicine
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Swietek, K. E., Gaynes, B. N., Jackson, G. L., Weinberger, M., & Domino, M. E. (2020). Effect of the Patient-Centered Medical Home on Racial Disparities in Quality of Care. J Gen Intern Med, 35(8), 2304–2313. https://doi.org/10.1007/s11606-020-05729-x
Swietek, Karen E., Bradley N. Gaynes, George L. Jackson, Morris Weinberger, and Marisa Elena Domino. “Effect of the Patient-Centered Medical Home on Racial Disparities in Quality of Care.J Gen Intern Med 35, no. 8 (August 2020): 2304–13. https://doi.org/10.1007/s11606-020-05729-x.
Swietek KE, Gaynes BN, Jackson GL, Weinberger M, Domino ME. Effect of the Patient-Centered Medical Home on Racial Disparities in Quality of Care. J Gen Intern Med. 2020 Aug;35(8):2304–13.
Swietek, Karen E., et al. “Effect of the Patient-Centered Medical Home on Racial Disparities in Quality of Care.J Gen Intern Med, vol. 35, no. 8, Aug. 2020, pp. 2304–13. Pubmed, doi:10.1007/s11606-020-05729-x.
Swietek KE, Gaynes BN, Jackson GL, Weinberger M, Domino ME. Effect of the Patient-Centered Medical Home on Racial Disparities in Quality of Care. J Gen Intern Med. 2020 Aug;35(8):2304–2313.
Journal cover image

Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

August 2020

Volume

35

Issue

8

Start / End Page

2304 / 2313

Location

United States

Related Subject Headings

  • Young Adult
  • White People
  • United States
  • Quality of Health Care
  • Patient-Centered Care
  • Middle Aged
  • Medicare
  • Medicaid
  • Humans
  • General & Internal Medicine