Effect of Patient-Centered Medical Home on Preventive Services for Adolescents and Young Adults.

Abstract

To determine the association between enrollment in patient-centered medical homes (PCMHs) and the receipt of preventive services among adolescents and young adults. 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. 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). Overall, patients enrolled in PCMHs had higher odds of receiving multiple preventive services.