Evidence of A Patient Centered Medical Home (pcmh) Improving the Health of Chronically Ill Patients in the Mississippi Delta - Evidence of A Patient Centered Medical Home (pcmh) Improving the Health of Chronically Ill Patients in the Mississippi Delta - Open Access Pub

Using proprietary data of patient records from four medical clinics in the Mississippi Delta, this research utilizes a natural experiment design to explore if the patient centered medical home (PCMH) has a positive effect on chronic disease maintenance for low SES, majority African-American patients in a rural and medically underserved region. The patients are divided into two cohorts, those attending PCMH clinics (level 2) and those attending non-PCMH clinics. Each cohort is comprised of similar demographic, socioeconomic, and health (large proportion of diabetics) characteristics. HbA1c scores of the cohorts are compared at two time periods, baseline and six-month follow-up. PCMH patients report more uncontrolled diabetes at baseline but the trend reverses at follow-up, providing evidence that the PCMH model of primary care produces positive health outcomes for patients with diabetes in the sample area. DOI10.14302/issn.2474-3585.jpmc-17-1449 Under the current model of primary care delivery in the United States, nearly three out of four American adults report difficulty getting an appointment, health care advice by phone, or off-hours care without going to an emergency room1. In order to meet this growing need for a more efficient and effective health care system in the United States, particularly in primary care, the patient-centered medical home (PCMH) model strives to strengthen the foundation of primary care services by improving the patient experience, improving the population’s overall health, and reducing the cost of care2, 3. PCMH effectiveness has been documented in these areas, as there have been reductions in health care costs, unnecessary utilization of emergency department (ED) visits, inpatient hospitalizations, hospital,4, 5 improved LDL6, blood pressure, and HbA1c.7, 8 The current evidence suggests that the PCMH model is working, but there remains an important gap in the literature regarding PCMH effectiveness in rural communities. Rural communities exhibit higher rates of chronic illness and mortality than urban communities9, 10, and racial and ethnic minorities in rural communities exhibit higher rates of disease and death than white rural Americans, making them doubly disadvantaged.11 Our research fills this place- and race-based gap in the literature by examining HbA1c improvement over time for patients with diabetes between PCMH and non-PCMH clinics located in an area of high health disparity. Why PCMH Matters in Mississippi and Rural America More Broadly The Mississippi Delta is a prime example of a rural region experiencing a