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Meta-Analysis
. 2018 Jun;53(3):1777-1798.
doi: 10.1111/1475-6773.12737. Epub 2017 Jul 3.

Do Patient-Centered Medical Homes Improve Health Behaviors, Outcomes, and Experiences of Low-Income Patients? A Systematic Review and Meta-Analysis

Carissa van den Berk-Clark  1 , Emily Doucette  1   2 , Fred Rottnek  1 , William Manard  1 , Mayra Aragon Prada  1 , Rachel Hughes  1 , Tyler Lawrence  1 , F David Schneider  1
Affiliations
Meta-Analysis

Do Patient-Centered Medical Homes Improve Health Behaviors, Outcomes, and Experiences of Low-Income Patients? A Systematic Review and Meta-Analysis

Carissa van den Berk-Clark et al. Health Serv Res. 2018 Jun.

Abstract

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.

Keywords: Patient-centered medical home; implementation; poverty; underserved patients.

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Figures

Figure 1
Figure 1
Article Identification and Selection Process for Patient‐Centered Medical Home Articles Included in the Systematic Review
Figure 2
Figure 2
Forest Plot of Average Effect Sizes of Clinical Outcomes, Utilization, Costs, Patient Adherence and Satisfaction, Quality of Care, and Provider Satisfaction
Figure 3
Figure 3
Funnel Plot of Average Effect Sizes of Clinical Outcomes, Utilization, Costs, Patient Adherence, and Satisfaction, Quality of Care, and Provider Satisfaction

  1. Notes. Larger point markings signify higher quality studies.

See this image and copyright information in PMC

References

    1. Andersen, R. M. 1995. “Revisiting the Behavioral Model and Access to Medical Care: Does It Matter?” Journal of Health and Social Behavior 36 (1): 1–10. - PubMed
    1. Arend, J. , Tsang‐Quinn J., Levine C., and Thomas D.. 2012. “The Patient‐Centered Medical Home: History, Components, and Review of the Evidence.” Mount Sinai Journal of Medicine 79: 433–50. - PubMed
    1. Balaban, R. B. , Weissman J. S., Samuel P. A., and Woolhandler S.. 2008. “Redefining and Redesigning Hospital Discharge to Enhance Patient Care: A Randomized Controlled Study.” Journal of General Internal Medicine 23 (8): 1228–33. - PMC - PubMed
    1. Beadles, C. A. , Farley J. F., Ellis A. R., Lichstein J. C., Morrisey J. P., Dubard C. A., and Domino M. E.. 2015. “Do Medical Homes Increase Medication Adherence for Persons with Multiple Chronic Conditions?” Medical Care 53 (2): 168–76. - PubMed
    1. Berry, C. A. , Mijanovich T., Albert S., Winther C. H., Paul M. M., Ryan M. S., McCullough C., and Shih S. C.. 2013. “Patient‐Centered Medical Home Among Small Urban Practices Serving Low‐Income and Disadvantaged Patients.” Annals of Family Medicine 11: S82–9. - PMC - PubMed

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