Exploring Patient Centered Care in a Rural Context: The Relationship Between Rural Residents' Age and Components of the Patient Centered Medical Home Model

Background: As social work continues to be in the forefront of effective universal health promotion, it is important social work researchers examine the healthcare experiences of all populations. This exploratory study examines results from a survey conducted with rural residents regarding a patient centered medical home model (PCMH) and aspects of the model residents value. The survey comprised of 70 items and was based on the Agency for Healthcare Research and Quality’s, (AHRQ) definition of a PCMH which encompasses five aspects of care: comprehensive; patient-centered; coordinated; accessible; and quality and safety.  Although research suggests PCMHs can positively impact numerous patient outcomes, little is known about how rural patients view the PCMH model. Thus, an exploration of patient views towards aspects included in AHRQ’s PCMH definition, specifically in a rural context, is needed. Based on the limited literature available, this study’s research question is ‘is there a relationship between age and rural patients’ views of the different functions of a PCMH based on the AHRQ definition’?

Methods: Data was collected via a cross-sectional survey administered over seven weeks to a convenience sample. The survey was distributed electronically using Qualtrics and was offered in paper format to encourage residents with limited Internet access to participate. The paper survey was distributed at federally qualified health centers in two rural counties in two mid-west states and research team members provided surveys at regularly scheduled meetings in several rural communities in two mid-west states. Three-hundred and sixty two (362) individuals completed at least 94% of the survey items either online or via paper. Researchers were not able to calculate a response rate because of snowball methodology.

Data Analysis: Five linear regression tests were conducted. Sum scores were calculated based on the respondents answers in the categories of questions which were aligned to AHRQ’s five aspects of a PCMH. In this study, there are five dependent variables: views on safety; comprehensive care; accessibility; patient-centered care; and coordinated care. This study’s variable of interest is respondent’s age. Control variables included prior PCMH knowledge, self-reported health rating, primary location of healthcare, and gender. Race was not included as a control variable due to little variation of this variable in the sample.

Results: The five linear regression tests revealed statistically significant results. Patients’ health status was significant in predicting views on health care accessibility and safety/quality. Age was a significant predictor regarding patients’ views of the importance of coordinated, safety/quality, and patient-centered care. The location where patients reported receiving care was also significant in predicting patient views regarding patient-centered and comprehensive care.

Implications: The findings may have significant implications for rural health care practices seeking to obtain PCMH designation and by knowing what age groups value in a medical home may allow practitioners, including social workers, to put more emphasis on certain elements. Furthermore, findings can be utilized by researchers to further explore how to better incorporate aspects of a PCMH model that patients value and deem essential in their healthcare.