• Jaya Aysola, Karin V Rhodes, and Daniel Polsky.
• *Department of Medicine, Perelman School of Medicine, Division of General Internal Medicine †Leonard Davis Institute of Health Economics ‡Department of Emergency Medicine, Perelman School of Medicine, Center for Emergency Care Policy & Research, University of Pennsylvania, Philadelphia, PA.
• Med Care. 2015 Oct 1; 53 (10): 857-62.

BackgroundRecent efforts to revitalize primary care have centered on the patient-centered medical home (PCMH). Although enhanced access is an integral component of the PCMH model, the effect of PCMHs on access to primary care services is understudied.ObjectiveTo determine whether PCMH practices are associated with better access to new appointments for nonelderly adults by direct measurement.Research DesignWe estimated the relationship between practice PCMH status and access to care in multivariate regression models, adjusting for a robust set of patient, practice, and geographic characteristics; using data on 11,347 simulated patient calls to 7266 primary care practices across 10 US states merged with data on PCMH practices.ParticipantsTrained field staff posing as patients (age younger than 65 y) seeking a new primary care appointment with varying insurance status (private, Medicaid, or self-pay).MeasuresOur primary predictor was practice PCMH status and our primary outcome was the ability of simulated patients to schedule a new appointment. Secondary outcomes included the number of days to that appointment; availability of after-hour appointments; and an appointment with an ongoing primary care provider.ResultsOf the 7266 practices contacted for an appointment, 397 (5.5%) were National Committee for Quality Assurance-recognized PCMHs. In adjusted analyses, callers to PCMH practices compared with non-PCMH practices were more likely to schedule a new appointment (adjusted odds ratio=1.26 (95% CI, 1.01-1.58); P=0.04] and be offered after-hour appointments [adjusted odds ratio=1.36 (95% CI, 1.04-1.75); P=0.02].DiscussionPCMH practices maybe associated with better access to new primary care appointments for nonelderly adults, those most likely to gain insurance under the Affordable Care Act.

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