THE PATIENT-CENTERED MEDICAL HOME: IMPACT ON RACIAL/ETHNIC DISPARITIES IN QUALITY OF CARE

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  • March 20, 2019
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  • Swietek, Karen
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
Abstract
  • Objective: The objective of this research is to investigate the effects of the patient-centered medical home (PCMH) model on disparities in quality of care among populations with major depressive disorder (MDD) and comorbid chronic physical conditions. Methods: Applying instrumental variable techniques to account for differential selection into treatment, we used generalized estimating equations and generalized linear models to determine the probability of receiving eight disease-specific quality measures for adults age 18-64 years with MDD and diabetes. Our independent variables of interest were enrollment in a National Committee for Quality Assurance (NCQA) recognized patient-centered medical home (PCMH), as well as level of NCQA recognition. We used a rank-and-replace method to measure disparities between racial groups, based on the Institute of Medicine definition. Results: We found that while PCMH enrollment may improve overall quality of care, the effect is inconsistent across racial groups and not always associated with reductions in racial/ethnic disparities in quality. We found no association between level of NCQA PCMH recognition and improvement in quality. Finally, we found that considerable HTE exists among PCMH enrollees, and this heterogeneity is driven by patient race, sex, age, rurality, and number of chronic comorbidities.   Conclusions: Our findings suggest that the PCMH model alone may be insufficient to meet the needs of diverse patient populations. Providers and policymakers should consider racial/ethnic disparities and heterogeneous treatment effects explicitly when designing, implementing, and evaluating PCMH programs.
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Advisor
  • Jackson, George
  • Gaynes, Bradley
  • Dilworth-Anderson, Peggye
  • Domino, Marisa
  • Weinberger, Morris
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2018
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