Patient-centered medical homes have been touted as a model of primary care that achieves better patient outcomes, but until recently there's been scant research on whether the benefits extend equally to all racial and ethnic groups. The verdict: Other groups still lag behind whites when it comes to the quality of their care, at least when it comes to diabetes or hypertension control.
The research, published in Health Affairs, began by examining data from 2009, which is when the Veterans Health Administration, a part of the Department of Veterans Affairs, began implementing patient-centered medical homes on a national scale -- what's known as the Patient Aligned Care Team Initiative. In that year, all groups -- African Americans, Native Americans, Hispanics, Asians and Pacific Islanders -- lagged behind caucasians when it came to care quality.
In 2014, the disparity for hypertension was similar for African Americans and improved only slightly for Hispanics, while multiracial individuals pulled even with whites. Native Americans and Pacific Islander experienced greater disparities over that time.
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For diabetes, the disparities in 2014 for Native Americans, African Americans and Hispanics were similar, while the relative outcomes for Native Hawaiians and Pacific Islanders improved to the point where they were no longer statistically different than whites.
In short, the benefits of the VA's patient-centered medical homes have been modest. They were mitigated, the report said, by external factors such as increased patient volume.
On the surface, the advantages of such facilities seems apparent enough. Patients in the medical homes are assigned to "teamlets" consisting of a primary care provider and staff members with expanded care delivery roles; the patient has access to same-day appointments, group visits and virtual communication with the PACT teamlet. Early evaluations of VA medical homes found that sites implementing that kind of approach performed better on most quality measures, hypertension and diabetes control among them.
Yet the research found reasons why racial and ethnic minorities might derive less benefit from the medical homes. For one, most minority veterans using the VA are concentrated in a relatively small number of facilities, and if the implementation of the model varies in systematic ways at these locations, that could open the door to disparities in care. And regardless of the model or its implementation, there are psychosocial and social support factors associated with race and ethnicity that may undermine access to care.
While some ethnic groups were able to pull close with whites over the study period, it wasn't always for good reasons. Hispanics narrowed the diabetes control gap, for example, but that was because outcomes were worse for all groups -- only slightly less so for Hispanics.
By contrast, it was simply better outcomes that led to Hispanics pulling closer to whites when it came to hypertension.
To promote greater health equity, the researchers suggested that patient-centered medical homes should craft strategies that account for determinants of racial and ethnic variations, and that evaluations of medical homes should monitor outcomes for racial and ethnic groups.