Duration of Medical Home Participation and Quality of Care for Patients with Chronic Conditions

Karen E. Swietek
Marisa Elena Domino
Lexie R. Grove
Chris Beadles
Alan R. Ellis
Joel F. Farley
Carlos Jackson
Jesse C. Lichstein
C. Annette DuBard
Peer-Reviewed Article
August 2021


Longer participation in a patient-centered medical home (PCMH) is associated with better mental health care for people enrolled in Medicaid with major depressive disorder (MDD) and multiple chronic conditions.


Multiple chronic conditions can impact the quality of mental health care for individuals with MDD, and individuals with MDD are less likely to receive high-quality mental health care that adheres to guidelines if they have multiple physical comorbidities. PCMHs have shown promise in enhancing care coordination and disease management for people with multiple chronic conditions, including MDD. This study examines whether the length of participation in PCMH leads to higher quality MDD care for North Carolina Medicaid beneficiaries with MDD and other chronic conditions.


The likelihood of receiving high-quality MDD care increased by 1.7 percentage points at four months of PCMH participation and 19.1 percentage points after 12 months of PCMH participation as compared to individuals who only had a single month of PCMH participation. This study also observed a racial difference in the likelihood of receiving high-quality MDD care, even with longer PCMH participation. Black enrollees had the largest disparity with a 14.3 percent reduction in the likelihood of receiving minimally adequate care as compared to non-Hispanic white enrollees.


Health care organizations that care for Medicaid enrollees with multiple chronic conditions and MDD may benefit from using the PCMH model for a longer duration to improve MDD care for this population.

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