Duration of medical home participation and quality of care for patients with chronic conditions

OBJECTIVE: To examine whether the length of participation in a patient‐centered medical home (PCMH), an evidence‐based practice, leads to higher quality care for Medicaid enrollees with multiple co‐morbid chronic conditions and major depressive disorder (MDD). DATA SOURCES: This analysis uses a unique data source that links North Carolina Medicaid claims and enrollment data with other administrative data including electronic records of state‐funded mental health services, a state psychiatric hospital utilization database, and electronic records from a five‐county behavioral health carve‐out program. STUDY DESIGN: This retrospective cohort study uses generalized estimating equations (GEEs) on person‐year‐level observations to examine the association between the duration of PCMH participation and measures of guideline‐concordant care, including the receipt of minimally adequate care for MDD, defined as 6 months of antidepressant use or eight psychotherapy visits each year. DATA COLLECTION/EXTRACTION METHODS: Adults with two or more chronic conditions reflected in administrative data, including MDD. PRINCIPAL FINDINGS: We found a 1.7 percentage point increase in the likelihood of receiving guideline‐concordant care at 4 months of PCMH participation, as compared to newly enrolled individuals with a single month of participation (p