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

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

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.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Chronic Disease / economics
  • Chronic Disease / therapy
  • Emergency Service, Hospital / statistics & numerical data
  • Health Behavior*
  • Health Services Research
  • Health Status
  • Humans
  • Medically Uninsured / statistics & numerical data
  • Mental Health
  • Patient Compliance / statistics & numerical data
  • Patient Satisfaction*
  • Patient-Centered Care / economics
  • Patient-Centered Care / statistics & numerical data*
  • Poverty / statistics & numerical data*
  • Treatment Outcome*