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Do Patient-Centered Medical Homes Improve Health Behaviors, Outcomes, and Experiences of Low-Income Patients? A
Carissa van den Berk-Clark1, Emily Doucette1,2, Fred Rottnek1
1Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO.
Objectives:
To examine: (1) what elements of patient-centered medical homes (PCMHs) are typically provided to low-income populations, (2) whether PCMHs improve health behaviors, experiences, and outcomes for low-income groups.
Data Sources/Study Setting:
Existing literature on PCMH utilization among health care organizations serving low-income populations.
Study Design:
Systematic review and meta-analysis.
Data Collection/Extraction Methods:
We obtained papers through existing systematic and literature reviews and via PubMed, Web of Science, and the TRIP databases, which examined PCMHs serving low-income populations. A total of 434 studies were reviewed. Thirty-three articles met eligibility criteria.
Principal Findings:
Patient-centered medical home interventions usually were composed of five of the six recommended components. Overall positive effect of PCMH interventions was d = 0.247 (range -0.965 to 1.42). PCMH patients had better clinical outcomes (d = 0.395), higher adherence (0.392), and lower utilization of emergency rooms (d = -0.248), but there were apparent limitations in study quality.
Conclusions:
Evidence shows that the PCMH model can increase health outcomes among low-income populations. However, limitations to quality include no assessment for confounding variables. Implications are discussed.
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