Graduation Date

Fall 12-14-2018

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research, Administration, and Policy

First Advisor

David W. Palm

Second Advisor

Fernando A. Wilson

Third Advisor

Thomas G. Tape

Fourth Advisor

Hyo Jung Tak


The Patient-Centered Medical Home has been endorsed by the primary care community as the model of the future, with hopes that it will increase quality of care and the patient and provider experience while decreasing costs. Many aspects of the implementation of the Patient-Centered Medical Home model remain unexplored. This dissertation comprises three independent studies examining Patient-Centered Medical Home implementation in the Military Health System, including (1) the effects of environmental correlates on the time to implement the model, (2) the impact of differences in implementation on preventive care quality outcomes, and (3) the effect of differences in implementation on chronic care quality outcomes.

Survival analysis was utilized to analyze the effect of environment, defined as resources and governance, on how long it took Military Health System clinics to adopt the Patient-Centered Medical Home model. Clinics were assumed to have adopted the model when they achieved National Committee on Quality Assurance recognition. Differences-in-differences models were created to compare both preventive and chronic care quality outcomes in Military Health System clinics by branch of service before and after Patient-Centered Medical Home implementation. Dependent variables included Chlamydia and various cancer screenings as well as heart condition and diabetes care HEDIS metrics. Measures were drawn from Military Health Mart, a patient-level utilization database, and aggregated at the clinic level. SPSS was used to analyze the data and we considered a p-value of less than .05 as statistical significance.

Our research suggests that, while the environmental correlates of resources and governance did impact the time to adoption of the Patient-Centered Medical Home model, differences in how the model was implemented had mixed results on both preventive and chronic care quality outcomes. The differences in significant measures were small. More research is needed on cost, utilization and patient/provider satisfaction to assess the impact of implementation differences.