The Effect of Patient-Centered Medical Homes (PCMH) on Rural Population Health
Open Access
- Author:
- Johannes, Bobbie Lynn
- Graduate Program:
- Health Policy and Administration
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- June 18, 2020
- Committee Members:
- Selena E Ortiz, Dissertation Advisor/Co-Advisor
Selena E Ortiz, Committee Chair/Co-Chair
Marianne Messersmith Hillemeier, Committee Member
Joel E Segel, Committee Member
Brian Clemens Thiede, Outside Member
Christopher Samuel Hollenbeak, Program Head/Chair - Keywords:
- rural
patient-centered medical home
PCMH
population health
care delivery
primary care
barriers to care
access to care
Andersen Framework of Healthcare Utilization
prevention
screening
tobacco use
smoking cessation
patient perceptions
pilot survey
improve health - Abstract:
- This dissertation investigated the effect of the patient-centered medical home (PCMH) on various outcomes that impact rural population health. Rural populations are unhealthier and have unique challenges to accessing and utilizing healthcare. Sociodemographic and environmental factors of rural populations are largely to blame for the poorer population health outcomes within rural America, and the complexity of these issues are discussed in Chapter 1. The case regarding why the PCMH may improve population health in rural communities by improving access to primary and specialty care, and thus increasing the receipt of preventive care is also outlined in Chapter 1. The Andersen model is used as the theoretical framework for this dissertation, and the relationship between these confounding factors and outcomes are detailed in Chapter 2. Chapter 3 examined whether rural patients whose usual source of care is a PCMH provider are more likely to receive recommended preventive services compared to rural patients receiving care from a non-PCMH. In addition, rural PCMH patients may be more likely to achieve behavioral health outcomes, such as smoking cessation—due to the formation of a relationship with a personal primary care physician. Therefore, Chapter 4 explored whether rural patients who receive care from a PCMH are more likely to receive smoking cessation advice and, as a result, successfully quit smoking compared to rural patients receiving care from a non-PCMH. Finally, Chapter 5 evaluated how rural patients perceive components of the PCMH, in regard to their ability to access primary care, access specialty care, receive preventive care, maintain or improve their health, and manage chronic conditions (if applicable). Patient perspectives are necessary to consider because they have largely been left out of the discussion regarding the PCMH model of care delivery. Moreover, the few studies that evaluate patients’ perspectives on the PCMH focus on urban populations. Chapter 6 provides an overall discussion of the results presented in this dissertation as well as their policy implications and concluding remarks.