Primary care attributes and mortality: a national person-level study

Area of Science:

• Health Services Research
• Public Health
• Epidemiology

Background:

• Geographic concentration of primary care clinicians is linked to area mortality.
• Evidence for individual-level mortality benefits of primary care is limited.
• The medical home model emphasizes specific primary care attributes.

Purpose of the Study:

• To examine if patient-reported access to primary care attributes is associated with lower individual mortality risk.
• To investigate the association between specific primary care attributes and patient mortality.

Main Methods:

• Analysis of 2000-2005 Medical Expenditure Panel Survey data (N=52,241) linked to the National Death Index.
• Construction of a primary care attributes score based on comprehensiveness, patient-centeredness, and enhanced access.
• Cox survival analysis adjusted for demographic, social, and health characteristics to assess mortality risk.

Main Results:

• Access to primary care attributes varied by socioeconomic status, race/ethnicity, insurance, health status, and region.
• A higher primary care attributes score was inversely associated with mortality (aHR=0.79, P=.03).
• Mortality decreased linearly with increasing access to primary care attributes.

Conclusions:

• Increased patient-reported access to key primary care attributes is associated with reduced mortality.
• Findings support the medical home model and the importance of its attributes for individual health.
• Ensuring patient access to comprehensive, patient-centered primary care may improve survival outcomes.