Amanda R Markovitz|Jeffrey A. Alexander|Paula M. Lantz|Michael L. Paustian
Patient-Centered Medical Home Implementation and Use of Preventive Services
Harvard University|Blue Cross Blue Shield of Massachusetts|University of Michigan–Ann Arbor|Milken Institute|George Washington University|Blue Cross Blue Shield of Michigan Foundation
patientcentered medical home pcmh model primary care implemented wide variety socioeconomic contexts yet little research whether effects differ context clinical preventive service use including cancer screening important outcome assess effectiveness pcmh within across socioeconomic contextsto determine whether relationship pcmh cancer screening conditional socioeconomic context primary care physician practice operatesa longitudinal study spanning july 1 2009 june 30 2012 using data blue cross blue shield michigan physician group incentive program conducted michigan nonpediatric primary care physician practices participated physician group incentive program 5452 practiceyears included sample size outlier exclusion criteria applied outcome examined interaction practices pcmh implementation scores socioeconomic context implementation pcmh selfreported practices affiliated physician organizations measured continuous score ranging 0 1 socioeconomic context calculated using marketbased approach based zip code characteristics practices patients combining multiple measures using principal components analysisbreast cervical colorectal cancer screening rates practices blue cross blue shield michigan patientsthe implementation pcmh associated higher breast cervical colorectal cancer screening rates across market socioeconomic contexts multivariable models pcmh associated higher rate screening breast cancer 54 95 ci 15 93 cervical cancer 42 95 ci 14 69 colorectal cancer 70 95 ci 36 105 lowest socioeconomic group nonsignificant differences screening breast cancer 26 95 ci 01 53 cervical cancer 05 95 ci 27 17 higher rate colorectal cancer 45 95 ci 18 73 screening highest socioeconomic group pcmh implementation associated larger increases screening lower socioeconomic practice settings models suggest reduced disparities screening rates across contexts example modelpredicted disparity breast cancer screening rates highest lowest socioeconomic contexts 6 779 vs 722 among practices pcmh implementation 3 803 vs 770 among practices full pcmh implementationin study pcmh model associated improved cancer screening rates across contexts may especially relevant practices lower socioeconomic areas