Neighborhood characteristics associated with access to patient-centered medical homes for children.

Understanding social determinants of health, such as the social and physical conditions under which children and their families live, work, and play, is essential to reducing disparities and improving the quality of primary care. We studied the relationship between perceptions of neighborhood characteristics such as cohesion, safety, physical environment, and whether children receive care from a patient-centered medical home. We found that place matters. Children were less likely to have access to a medical home if they were from less socially cohesive neighborhoods, less safe neighborhoods, or neighborhoods with fewer amenities. These associations persisted even after adjustment for socioeconomic factors and proved to be more strongly associated than race and income. Our findings underscore the need to foster medical practice models that make use of trusted community partners, such as churches and schools, expand care teams to include community health workers, and identify additional ways to build collaborative relationships between providers and their patients and their families from less cohesive neighborhoods.