PCMH Model Narrows Economic Gap for Cancer Screening

Marcia Frellick

February 18, 2015

Patient-centered medical homes (PCMHs) may raise cancer screening rates, especially among groups of lower socioeconomic status, researchers have found.

"Disparities in care have been well documented but rarely successfully addressed," Mitchell H. Katz, MD, director of the Los Angeles County Department of Health Services writes in an editorial that accompanies the study. "It is heartening to see that a key intervention in health reform — the creation of patient-centered medical homes — may finally help us to narrow the gaps in our health care system that exist across socioeconomic status."

Amanda Markovitz, MPH, from the Department of Clinical Epidemiology and Biostatistics, Blue Cross Blue Shield of Michigan in Ann Arbor, and colleagues compared PCMH implementation scores and their socioeconomic context, using data from the from 2218 primary care practices in the insurer's Physician Group Incentive Program from 2009 to 2012. Then they looked at rates of breast, cervical, and colorectal cancer screening.

In the lowest socioeconomic group, implementation of the PCMH model was associated with a higher rate of screening for breast cancer (5.4%; 95% confidence interval, 1.5% - 9.3%), cervical cancer (4.2%; 95% CI, 1.4% - 6.9%), and colorectal cancer (7.0%; 95% CI, 3.6% - 10.5%).

However, in the highest economic group, there were no significant differences in screening for breast cancer (2.6%; 95% CI, −0.1% to 5.3%) and cervical cancer (−0.5%; 95% CI, −2.7% to 1.7%) and a higher rate of colorectal cancer (4.5%; 95% CI, 1.8% - 7.3%) screening.

Using breast cancer screening as an example, the researchers found that the gap for screening between the groups of highest and lowest socioeconomic status was 6% with no PCMH (77.9% vs 72.2%), or double the disparity under the full PCMH model, which was 3% (80.3% vs 77.0%).

The results were published online February 16 in JAMA Internal Medicine.

In the editorial, Dr Katz notes that the results make sense, given the access issues of lower-income patients. However, he adds that a prominent feature of PCMHs is electronic health records and notes that technology can help facilitate screening.

With an electronic health record, health systems can determine which patients need prevention screening without the patients having to come in for a visit. Some screenings also can be done by mail or at a convenient center instead of requiring a visit first to a primary care office.

Markovitz and a coauthor were employed by Blue Cross Blue Shield of Michigan during the study. Funding was received from the Agency for Healthcare Research and Quality and the National Institutes of Health. The other authors and Dr Katz have disclosed no relevant financial relationships.

JAMA Intern Med. Published online February 16, 2015. Article abstract, Editorial extract

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