Effect of the Patient-Centered Medical Home on Racial Disparities in Quality of Care for Persons with Major Depressive Disorder

Persons with multiple chronic conditions utilize health care services more frequently and access a wider range of services than the general population, making coordination of their care more difficult. Because mental health problems also exacerbate the disability associated with physical disorders and complicate their management, these coordination challenges make persons with co-occurring mental illnesses such as depression particularly vulnerable to suboptimal quality of care. This intersection between psychiatric co-morbidity and chronic conditions may also be intensified among racial minorities. The patient-centered medical home (PCMH) model is an increasingly popular method to improve quality of care for this complex population. But while the rationale for PCMH transformation is well-documented, different patient populations may not benefit equally from this model, and the effect of PCMH on racial disparities in quality of care is unknown. The objective of this study is to estimate the effect of PCMH enrollment on racial/ethnic disparities in quality of care for adults with depression and one or more other chronic medical conditions.

Using 2008-2012 Medicaid claims merged with practice-level data on NCQA-recognized PCMHs, this retrospective cohort study compares racial/ethnic disparities in claims-based disease-specific quality measures for depression, asthma, and diabetes adults with depression and co-morbid physical conditions who are enrolled in a PCMH to their counterparts receiving usual primary care. The analysis controls for selection into the PCMH using county rates of PCMH adoption as an instrumental variable. This study has important policy implications as it contributes to a more detailed understanding of how the PCMH model affects quality of care for diverse populations.