Duration of medical home participation and quality of care for patients with chronic conditions.

Objective: To examine whether the length of participation in a patient-centered medical home (PCMH), an evidence-based practice, leads to higher quality care for Medicaid enrollees with multiple co-morbid chronic conditions and major depressive disorder (MDD).

Data Sources: This analysis uses a unique data source that links North Carolina Medicaid claims and enrollment data with other administrative data including electronic records of state-funded mental health services, a state psychiatric hospital utilization database, and electronic records from a five-county behavioral health carve-out program.

Study Design: This retrospective cohort study uses generalized estimating equations (GEEs) on person-year-level observations to examine the association between the duration of PCMH participation and measures of guideline-concordant care, including the receipt of minimally adequate care for MDD, defined as 6 months of antidepressant use or eight psychotherapy visits each year.

Access to the Medical Home Among Children With and Without Special Health Care Needs.

Unlabelled: : media-1vid110.1542/5840358562001PEDS-VA_2018-1795 OBJECTIVES: The medical home is central to providing quality health care for children. Access to the medical home has historically been tracked by using the National Survey of Children With Special Health Care Needs and the National Survey of Children's Health (NSCH).

Evaluating the potential for primary care to serve as a mental health home for people with schizophrenia.

Objective: Primary care-based medical homes could improve the coordination of mental health care for individuals with schizophrenia and comorbid chronic conditions. The objective of this paper is to examine whether persons with schizophrenia and comorbid chronic conditions engage in primary care regularly, such that primary care settings have the potential to serve as a mental health home.

Method: We examined the annual primary care and specialty mental health service utilization of adult North Carolina Medicaid enrollees with schizophrenia and at least one comorbid chronic condition who were in a medical home during 2007-2010.

Do primary care medical homes facilitate care transitions after psychiatric discharge for patients with multiple chronic conditions?

Objective: Primary-care-based medical homes may facilitate care transitions for persons with multiple chronic conditions (MCC) including serious mental illness. The purpose of this manuscript is to assess outpatient follow-up rates with primary care and mental health providers following psychiatric discharge by medical home enrollment and medical complexity.

Methods: Using a quasi-experimental design, we examined data from North Carolina Medicaid-enrolled adults with MCC hospitalized with an inpatient diagnosis of depression or schizophrenia during 2008-2010.

First outpatient follow-up after psychiatric hospitalization: does one size fit all?

Objective: Claims-based indicators of follow-up within seven and 30 days after psychiatric discharge have face validity as quality measures: early follow-up may improve disease management and guide appropriate service use. Yet these indicators are rarely examined empirically. This study assessed their association with subsequent health care utilization for adults with comorbid conditions.

Do medical homes increase medication adherence for persons with multiple chronic conditions?

Background: Medications are an integral component of management for many chronic conditions, and suboptimal adherence limits medication effectiveness among persons with multiple chronic conditions (MCC). Medical homes may provide a mechanism for increasing adherence among persons with MCC, thereby enhancing management of chronic conditions.

Objective: To examine the association between medical home enrollment and adherence to newly initiated medications among Medicaid enrollees with MCC.

Use of medical homes by patients with comorbid physical and severe mental illness.

Background: Patients with comorbid severe mental illness (SMI) may use primary care medical homes differently than other patients with multiple chronic conditions (MCC).

Objective: To compare medical home use among patients with comorbid SMI to use among those with only chronic physical comorbidities.

Research Design: We examined data on children and adults with MCC for fiscal years 2008-2010, using generalized estimating equations to assess associations between SMI (major depressive disorder or psychosis) and medical home use.

Heterogeneity in the quality of care for patients with multiple chronic conditions by psychiatric comorbidity.

Background: Little is known about the quality of care received by Medicaid enrollees with multiple chronic conditions (MCCs) and whether quality is different for those with mental illness.

Objectives: To examine cancer screening and single-disease quality of care measures in a Medicaid population with MCC and to compare quality measures among persons with MCC with varying medical comorbidities with and without depression or schizophrenia.

Research Design: Secondary data analysis using a unique data source combining Medicaid claims with other administrative datasets from North Carolina's mental health system.