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Overlapping geographic clusters of medical homes and community health outcomes: measures of social vulnerability that predict primary care access in the U.S.

Authors: Nathaniel Bell*, University of South Carolina
Topics: Medical and Health Geography, Population Geography, Applied Geography
Keywords: medical home, patient-centered care, socioeconomic factors, geographic factors
Session Type: Paper
Presentation File: No File Uploaded

Geography is a strong yet often ignored predictor for determining the amount and kind of health care services people receive. A good of example of this paradox can be seen in evaluations of health care reform efforts to transition primary care delivery into patient-centered medical home (PCMH) modeled care. Under the PCMH model, providers serve as the central point of care contact for all of a patient’s primary health care needs. In addition, they are also tasked with helping patients navigate the health system and connect them to specialists or other providers when appropriate. Yet studies continue to show, variously, that medical homes are not uniformly entering into the marketplace, thereby leading to geographic variations in care access and indirectly reinforcing long-standing barriers to care that disproportionately affect socially marginalized populations. In this paper, I discuss the role of geography in health care reform efforts to improve primary care quality in the U.S. Using linked administrative databases, I show how overlapping geographic clusters of poor health outcomes and PCMH saturation generally follow consistent patterns with county-level social and demographic characteristics. The causal mechanisms that underline these associations are important to display given the potential capacity of medical homes to become responsive to new payment arrangements and initiatives that may soon require providers to screen for a patient’s social needs.

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