Document Type


Subject Area(s)

Humans; Outcome Assessment, Health Care; Patient-Centered Care; Poverty; Social Determinants of Health; Socioeconomic Factors


The collaborative design of America's patient-centered medical homes places these practices at the forefront of emerging efforts to address longstanding inequities in the quality of primary care experienced among socially and economically marginalized populations. We assessed the geographic distribution of the country's medical homes and assessed whether they are appearing within communities that face greater burdens of disease and social vulnerability. We assessed overlapping spatial clusters of mental and physical health surveys; health behaviors, including alcohol-impaired driving deaths and drug overdose deaths; as well as premature mortality with clusters of medical home saturation and community socioeconomic characteristics. Overlapping spatial clusters were assessed using odds ratios and marginal effects models, producing four different scenarios of resource need and resource availability. All analyses were conducted using county-level data for the contiguous US states. Counties having lower uninsured rates and lower poverty rates were the most consistent indicators of medical home availability. Overall, the analyses indicated that medical homes are more likely to emerge within communities that have more favorable health and socioeconomic conditions to begin with. These findings suggest that intersecting the spatial footprints of medical homes in relation to health and socioeconomic data can provide crucial information for policy makers and payers invested in narrowing the gaps between clinic availability and the communities that experience the brunt of health and social inequalities.

Digital Object Identifier (DOI)


© 2020 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (

APA Citation

Bell, N., Wilkerson, R., Mayfield-Smith, K., & Lòpez-De Fede, A. (2021). Community social determinants and health outcomes drive availability of patient-centered medical homes. Health & Place, 67, 102439.

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Nursing Commons