OBJECTIVE: To determine the association between enrollment in patient-centered medical homes (PCMHs) and the receipt of preventive services among adolescents and young adults. METHODS: Retrospective cohort study including patients of Hennepin County aged 10 to 24 who had face-to-face or telephone encounters with health care providers between 2010 and 2014 at clinics with PCMHs at the Hennepin County Medical Center, Minnesota. Exposure was enrollment in PCMHs. Outcomes were receipt of (1) preventive visits; (2) prescriptions for influenza, meningococcal, and human papillomavirus vaccinations; (3) screening for sexually transmitted infections; (4) prescription of any contraceptive and long-acting reversible contraceptives; and (5) cervical cancer screening. Generalized mixed effect models in a propensity-score-matched sample were used for data analysis. RESULTS: Overall, 21 704 patients were included. Most patients were female, US-born, Hispanic/Latino, with an average age of 20.8 years. Patients enrolled in PCMH (n = 729) were more likely to be Latino, students, and have health insurance (P < .001). Adjusted odds ratios (99% confidence intervals) comparing the receipt of preventive services of patients enrolled in PCMHs to youth who did not receive these services were as follows: (1) preventive visits 1.10 (0.93-1.29); (2) influenza 0.89 (0.74-1.07), meningococcal 1.53 (1.30- 1.80), and human papillomavirus vaccinations 1.53 (1.28-1.84); (3) screening for sexually transmitted infections 1.69 (1.28-2.24); (4) prescription of any type of contraception 2.18 (1.56-3.03) and long-acting reversible contraceptives 2.66 (1.89-3.74); and (5) cervical cancer screening 1.14 (0.87-1.48). CONCLUSIONS: Overall, patients enrolled in PCMHs had higher odds of receiving multiple preventive services.
Bibliographical noteFunding Information:
Research reported in this article was supported by the Eliminating Health Disparities Initiative of the Minnesota Department of Health (principal investigator: Svetaz) and by the National Research Service Award in Primary Medical Care (grant T32HP22239), Bureau of Health Professions, Health Resources and Services Administration, Department of Health and Human Services (principal investigator: Borowsky). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding institutions.
Copyright © 2016 by the American Academy of Pediatrics.