Patient-centered medical homes and preventive service use

Despite data suggesting that patient-centered medical homes (PCMHs) improve preventive service use, limited nationally representative evidence exists. This study compared preventive service use between patients with and without a usual source of care (USC) and, of the patients with a USC, between those in practices with and without PCMH status.

This study used a cross-sectional study design.

We constructed general and disease-specific preventive service indicators using the 2015 Medical Expenditure Panel Survey. Preventive service rates were compared between patients reporting a USC versus no USC and between patients whose USC practices were PCMH certified versus not PCMH certified. Unadjusted outcomes were tested using χ2 tests. Multivariable logistic regression was used to test differences between groups, controlling for predisposing, enabling, and need variables.

Using multivariable logistic regression, respondents with a USC reported higher rates of screening for breast cancer (odds ratio [OR], 2.40; 95% CI, 1.81-3.17) and cervical cancer (OR, 1.99; 95% CI, 1.61-2.47) than respondents with no USC. Diabetes respondents with a USC had higher odds of an annual eye exam (OR, 2.05; 95% CI, 1.26-3.33) than respondents with no USC. Diabetes respondents with a USC that was PCMH certified reported higher rates of annual foot screenings (OR, 2.01; 95% CI, 1.31-3.08) and lower rates of annual cholesterol screenings (OR, 0.30; 95% CI, 0.11-0.83) than those with a USC that was not PCMH certified.

Having a USC was associated with higher rates of several preventive screening measures. However, there were fewer significant preventive screening relationships by PCMH status among individuals with a USC. Our results suggest that improving access to a USC may be as important as the application of PCMH principles to a USC practice.