Background: Primary care practices are transforming the way that they provide care by increasing their medical home infrastructure. However, previous studies have shown variation in the implementation of these medical home functions across different practices types.
Goal: This study aims to explore the degree to which medical home functions have been implemented by primary care practices that care for adults with severe psychological distress (SPD).
Objectives: Early work has also shown that adults with mental illness can significantly benefit from receiving their primary care through a medical home. The objective of this study is to examine the degree to which medical home functions have been implemented by primary care practices that care for adults with severe psychological distress (SPD), a proxy measure of mental illness. We also aim to examine whether adults with SPD are more or less likely to receive primary care from practices that have implemented the medical home functions as compared to adults without SPD.
Approach: Analysis of the 2015 Medical Expenditure Panel Survey (MEPS) Household Component and Medical Organizations Survey (MOS). This unique data set links data from a nationally representative sample of US households to the practices in which they receive primary care.
Results: Multivariate models that were adjusted for patient-level and practice-level characteristics indicated that adults with SPD (N=267, representing 3,658,230 Americans) were not any more or less likely to receive care from practices that have implemented the functions of a medical home that adults without SPD, including case management, electronic health records, flexible scheduling, and Patient Centered Medical Home (PCMH) certification. We did however find that adults with SPD were significantly more likely to be cared for in practices that provided individualized quality reports to their physicians (AOR=2.06, 95% CI 1.13-3.77).
Importance to public health: Although we found that adults with SPD receive care from different types of practices than adults without SPD, we did not find much difference between the two groups as related to the medical home functionality of their site of primary care. Due to their complex medical and psychosocial comorbidities, adults with mental illness have significant potential to benefit from primary care that is delivered through a medical home.