This study examines the association between where pediatric Medicaid patients in South Carolina live and their use of patient-centered medical homes (PCMHs) instead of hospitals for health care.
Study Overview
Problem: Patient-centered medical homes (PCMHs) provide primary care using a model designed to put patients at the center of care that is comprehensive, coordinated, accessible, safe, and high-quality. In South Carolina, PCMHs participating in Medicaid Managed Care are available across the State. However, PCMHs are generally concentrated in only four counties, and 10% of the State’s Medicaid population does not have a PCMH in the county where they live. Little is known about how much travel distance impacts the use of PCMHs.
Main Objective: To better understand the impact of where a patient lives on their use of a PCMH instead of a hospital for care.
Approach: The research team used pediatric medical claims data in South Carolina from the years 2016-2018 to identify PCMH enrollment and examine proximity to a PCMH versus a hospital for children with pre-existing ADHD (2,959 Medicaid beneficiaries) and asthma (6,390 Medicaid beneficiaries). Using primary care quality indicators, such as the number of avoidable emergency department encounters, the researchers then examined the relationship between travel distance and utilization rates.
Results: The research team found that low rates of uninsured and low poverty rates are the most consistent indicators of PCMH availability in a county.1 Among children in the ADHD cohort enrolled at a PCMH, the researchers found that avoidable emergency department use decreased as proximity to a PCMH improved relative to a hospital.2 This evidence suggests that the distance between patients and PCMHs plays a role in PCMH use—at least for pediatric groups with certain pre-existing conditions. This finding may also help to explain disappointing results in prior PCMH research studies that lacked geographic information for patients. Publications from this grant are posted here.
Primary Care Relevance
This research helps to better understand how travel distance impacts PCMH utilization. Findings could lead to policy reform to establish guidelines to increase access to PCMHs among Medicaid patients.
AHRQ Primary Care Priority Area
Research to improve primary care, including regarding quality, access and affordability, the workforce, care delivery models, financing, digital healthcare, person-centeredness, and health equity.
Notes
1. Bell N, Wilkerson R, Mayfield-Smith K, Lòpez-De Fede A. Community social determinants and health outcomes drive availability of patient-centered medical homes. Health Place 2021 Jan;67:102439. doi: 10.1016/j.healthplace.2020.102439. Epub 2020 Nov 16. PMID: 33212394.
2. Bell N, Lòpez-De Fede A, Cai B, Brooks J. Geographic proximity to primary care providers as a risk-assessment criterion for quality performance measures. PLoS One 2022 Sep 6;17(9):e0273805. doi: 10.1371/journal.pone.0273805. PMID: 36067180; PMCID: PMC9447909.
