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Document Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Degree Program

Public Health

Year Degree Awarded

2017

Month Degree Awarded

February

First Advisor

Rosa Rodriguez-Monguio

Second Advisor

Elaine Puleo

Third Advisor

Joan Roche

Subject Categories

Health Services Research

Abstract

Background. Patient-centered medical homes (PCMHs) may improve outcomes for non-elderly adults with mental illness while containing the cost of care. However, additional research is needed to assess the association between receipt of care consistent with the PCMH and preventive care, healthcare quality, healthcare services utilization, and healthcare services cost for a nationally representative sample of non-elderly adults with mental illness in the United States. Research is also needed to examine whether non-elderly adults with mental illness receive care consistent with the PCMH.

Methods. A surveillance study was conducted using self-reported data for a nationally representative sample of non-elderly adults participating in the 2007-2012 Medical Expenditure Panel Survey. Multiple regression models were developed to examine: 1) the association between mental illness and receipt of care consistent with the PCMH; 2) the associations between receipt of care consistent with the PCMH and preventive care and healthcare quality for non-elderly adults with mental illness; and 3) the associations between receipt of care consistent with the PCMH and healthcare services utilization and cost for non-elderly adults with mental illness.

Results. Compared to non-elderly without mental illness, non-elderly adults with mental illness were more likely to receive care with some individual PCMH attributes, but they did not have significantly different odds of receiving care consistent with the PCMH. Compared to participants with mental illness who had a non-PCMH usual source of care (USC), participants with mental illness who received care consistent with the PCMH had better odds of meeting only one preventive care or healthcare quality measure (out of seven measures examined). Differences between participants with mental illness who received care consistent with the PCMH and participants with mental illness who had a non-PCMH USC were not statistically significant for any healthcare services utilization or expenditures measures.

Conclusions. The study findings raise concerns about the potential value of the PCMH for non-elderly adults with mental illness and suggest that alternative models of primary care are needed to improve outcomes for this population. Research assessing whether the PCMH is a cost-effective model of care for non-elderly adults with mental illness is needed.

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