Association between Patient-Centered Medical Home (PCMH) Care Concordance and Cancer Screening Use in Federally Qualified Health Centers (FQHCs) Open Access
Chen, Steven (Spring 2020)
Abstract
Cancer is a leading cause of morbidity and mortality in the United States. Federally qualified health centers (FQHCs) are a critical component of the health care safety net and expand access to preventive services, including cancer screening, for underserved populations. In recent years, FQHCs have demonstrated substantial interest in the patient- centered medical home (PCMH) model, a widely-promoted approach to restructure primary care delivery in alignment with five domains: (1) team-based, comprehensive care, (2) care coordination and integration, (3) patient-centered orientation, (4) enhanced access aligned to patient preferences, and (5) continuous quality improvement. The literature to date has suggested that health center patients receiving PCMH-concordant care are more likely to receive recommended cervical and colorectal cancer screenings; however, these studies leveraged health center-reported estimates of PCMH care concordance and cancer screening use, which may be inaccurate due to measurement error. In addition, no study has provided nationally representative estimates of breast cancer screening utilization at FQHCs. This study uses national, patient-reported data (2014 Health Center Patient Survey) to investigate whether PCMH care concordance at FQHCs is associated with breast, cervical, and colorectal cancer screening use. Logistic regression models, adjusted to account for the complex survey design elements of the data, offer evidence of a positive association between PCMH care concordance and cervical cancer screening, mixed evidence regarding a possible association between PCMH concordance and colorectal cancer screening, and no evidence of an association between PCMH concordance and breast cancer screening. These findings underscore the potential for the PCMH model to improve cancer screening use in health centers, and highlight the need for additional research using patient-reported data into how PCMH practice transformation may facilitate improved cancer screening rates in primary care practices whose patients are primarily from low-income, medically underserved populations.
Table of Contents
Chapter 1: Introduction 1
Chapter 2: Literature Review 4
Cancer Screening and Federally Qualified Health Centers (FQHCs)
The Patient-Centered Medical Home (PCMH)
PCMH in FQHCs
PCMH and Cancer Screening
Literature Gap
Chapter 3: Methods 18
Theory and Conceptual Framework
Hypotheses
Dataset
Analytic Sample
Constructs and Measures
Analytic Strategy
Chapter 4: Results 43
Descriptive Statistics
Logistic Regression
Sensitivity Analyses
Supplemental Analyses
Chapter 5: Discussion 59
Summary of Results
Implications
Strengths and Limitations
Policy Relevance
Chapter 6: Conclusion 69
References 70
Appendices 73
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