Rural-urban differences in the patient-centered medical home for patients with severe mental illness

In rural areas, patients with severe mental illness (i.e. major depression, bipolar disorder and schizophrenia) (SMI) have more difficulty accessing mental health services; therefore, the responsibility for addressing both physical and mental needs often falls to rural primary care providers. The patient-centered medical home (PCMH) has been proposed as a model for prevention, care coordination, and management of chronic disease. To date, the performance of the model in rural versus urban areas remains unknown. This analysis evaluated differences in utilization and quality of care between rural and urban PCMHs for adult Medicaid patients with SMI. Claims data from North Carolina Medicaid's Community Care of North Carolina (CCNC) program were used. Propensity score weighting methods adjusted for Medicaid beneficiary self-selection into the PCMH. A difference-in-differences regression approach was estimated using generalized estimating equations to show how utilization and quality of care in rural PCMHs differ from urban PCMHs. Preliminary findings show, on average, that patients with SMI in urban PCMHs use more health and mental health services and are more adherent to their prescription medications than patients in rural PCMHs. Patients with SMI in both urban and rural PCMHs use less health and mental health services, but are more adherent to their prescription drugs than patients with SMI in traditional fee-for-service (non-PCMH). Understanding rural-urban what differences exist in terms of access and quality of care for patients with SMI in the PCMH model will help address the challenges of managing care for patients with SMI in rural primary care practices.