Dissertations & Theses (Open Access)

Date of Award

12-2019

Degree Name

Doctor of Public Health (DrPH)

Advisor(s)

J Michael Swint

Second Advisor

Robert Morgan

Third Advisor

Wenyaw Chang

Abstract

The patient-centered medical home (PCMH) model is a care delivery model which patient treatment is coordinated through their primary care physician to ensure they receive the necessary care when and where they need it, in a manner they can understand with the aims to improve healthcare quality while keeping healthcare cost growth under control. The objective of this study was to analyze health service utilization, expenditure and quality of civilian noninstitutionalized US adult population in healthcare facilities that have 3 domains of PCMH features, which are comprehensive care, patient-centered care, and accessible care, using patient’s perspective from the 2016 Medical Expenditure Panel Survey (MEPS) data. The analysis was done using regression analysis with complex survey method. While univariate models show significant associations between the receipt of care from providers that patient considered having characteristics consistent with the 3 domains of PCMH model and number of health service utilizations (ambulatory visits, emergency room visits, and prescription medication refills) and healthcare expenditures (total healthcare expenditures and total emergency department expenditures), no associations were found after controlling for individual demographic and socioeconomic characteristics in all but one measure. Number of ambulatory visits decreased slightly with the perception of receiving care consistent with the 3 domains of the PCMH model. No significant difference were observed in both adjusted and unadjusted model for number of hospital discharges, total inpatient expenditures, total ambulatory expenditures, total pharmaceutical expenditures, as well as healthcare quality for diabetic patients (HbA1c testing, blood cholesterol testing, dilated eye examination, feet examination, and flu vaccination). However, there were evidences of associations between those outcomes and several social health determinant factors such as age, gender, education, insurance coverage, and self-report health status. Even though there was no evidence of associations between overall patient-perceived PCMH care in terms of comprehensive care, patient-centered care, and accessible care and healthcare utilization, expenditure, and quality, additional research on the effects of specific PCMH attributes on health outcomes in both general population and specific population with chronic illness may provide better understanding of the impact of the PCMH model on achieving quality care at sustainable costs.

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