title: Community-level sociodemographic characteristics and patient-centered medical home capacity.
abstract: OBJECTIVE
  Longitudinally (2008-2012) assess whether community-level sociodemographic characteristics were associated with patient-centered medical home (PCMH) capacity among primary care and specialty physician practices, and the extent to which variation in PCMH capacity can be accounted for by sociodemographic characteristics of the community.
  
  
  METHODS
  Linear growth curve models among 523 small and medium-sized physician practices that were members of a consortium of physician organizations pursuing the PCMH.
  
  
  RESULTS
  Our analysis indicated that the average level of sociodemographic characteristics was typically not associated with the level of PCMH capacity, but the heterogeneity of the surrounding community is generally associated with lower levels of capacity. Furthermore, these relationships differed for interpersonal and technical dimensions of the PCMH.
  
  
  CONCLUSIONS
  Our findings suggest that PCMH capabilities may not be evenly distributed across communities and raise questions about whether such distributional differences influence the PCMH's ability to improve population health, especially the health of vulnerable populations. Such nuances highlight the challenges faced by practitioners and policy makers who advocate the continued expansion of the PCMH as a means of improving the health of local communities.
  
  
  CONCLUSIONS
  To date, most studies have focused cross-sectionally on practice characteristics and their association with PCMH adoption. Less understood is how physician practices' PCMH adoption varies as a function of the sociodemographic characteristics of the community in which the practice is located, despite work that acknowledges the importance of social context in decisions about adoption and implementation that can affect the dissemination of innovations.
authors.forename: Larry R
authors.initials: LR
authors.lastname: Hearld
authors.forename: Kristine R
authors.initials: KR
authors.lastname: Hearld
authors.forename: Tory H
authors.initials: TH
authors.lastname: Hogan
mesh_terms: D000367:Age Factors; D019468:Disease Management; D006801:Humans; D008511:Medicine / Q000458:organization & administration*; D018802:Patient-Centered Care / Q000458:organization & administration*; D011314:Preventive Health Services / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D011364:Professional Practice / Q000458:organization & administration*; D011369:Professional-Patient Relations; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012648:Self Care; D012959:Socioeconomic Factors; D014481:United States