Patient-centered medical homes based at federally-qualified health centers (FQHCs) can benefit patients with complex health needs, such as severe mental illness (SMI). However, little is known about FQHC characteristics associated with changes in health care expenditures and utilization for individuals with SMI. Using North Carolina Medicaid claims and FQHC data from the Uniform Data System, multivariate regression identified FQHC characteristics associated with total expenditures, medication adherence and emergency department utilization among adults with SMI, controlling for time-invariant differences by health center. Few of the FQHC-level factors affected the outcomes—not even offering on-site behavioral health services. Although the FQHCs in the analysis sample exhibited considerable variation in the provision of specialty behavioral services and in staffing configurations, it may be the case that the examination of average effects across a heterogeneous group of adults with SMI mask benefits of FQHCs to certain subgroups. These findings support the conclusion that there is no “one-size-fits-all” model that works best for this diverse patient population. Study results are relevant for practices embarking on expanded medical home services for people with SMI.

中文翻译：

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某些健康中心是否为患有严重精神疾病的人提供更好的以患者为中心的医疗之家？

以患者为中心的医疗之家位于具有联邦资格的健康中心 (FQHC)，可以使有复杂健康需求的患者受益，例如严重的精神疾病 (SMI)。然而，对于与 SMI 患者的医疗保健支出和利用率变化相关的 FQHC 特征知之甚少。使用来自统一数据系统的北卡罗来纳州医疗补助索赔和 FQHC 数据，多元回归确定了与 SMI 成人的总支出、药物依从性和急诊科利用率相关的 FQHC 特征，控制了健康中心的时间不变差异。FQHC 层面的因素很少会影响结果——甚至不提供现场行为健康服务。尽管分析样本中的 FQHC 在提供专业行为服务和人员配置方面表现出相当大的差异，但可能是对具有 SMI 的异质成年人群体的平均影响的检查掩盖了 FQHC 对某些亚组的益处。这些发现支持这样的结论，即没有“一刀切”的模型最适合这种多样化的患者群体。研究结果与为 SMI 患者开展扩大医疗家庭服务的实践相关。这些发现支持这样的结论，即没有“一刀切”的模型最适合这种多样化的患者群体。研究结果与为 SMI 患者开展扩大医疗家庭服务的实践相关。这些发现支持这样的结论，即没有“一刀切”的模型最适合这种多样化的患者群体。研究结果与为 SMI 患者开展扩大医疗家庭服务的实践相关。