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HERD. 2019 Jul;12(3):187-205. doi: 10.1177/1937586718806866. Epub 2018 Dec 3.

A Regional Survey on Residents' Preferences on Patient-Centered Medical Home Design in Rural Areas.

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1 Department of Architecture, the University of Kansas, Lawrence, KS, USA.
2 School of Social Welfare, the University of Kansas, Lawrence, KS, USA.
3 Department of Architecture, University of Cambridge, Cambridge, UK.



This study aims to explore the rural residents' preferences on various aspects of the patient-centered medical home (PCMH) model and the associated physical environment features.


The PCMH model has gained popularity as an innovative care model that intends to improve patient experience and outcomes while reducing costs. Yet few studies focused on patients' perspective, even less considered the needs of the rural communities.


Using a convenience sample, an exploratory survey was completed by 362 rural residents in the Midwestern region. Survey items were designed to gather information on both rural residents' preferences for five key PCMH attributes (comprehensive, patient-centered, coordinated, accessible, and quality) and of the physical environment that supports these attributes. Analyses were arranged along these key attributes.


Results indicated that residents' demographics affect their preferences for spatial features for PCMH. The three most important environmental factors for PCMH for the rural residents are the privacy, extra chairs in the exam room for family, and space that supports information sharing and communication among patient, family, and healthcare staff. Through structural equation modeling analysis, residents' preferences on comprehensive care, patient-centered care, coordinated care, quality, and safety have shown to affect their preference for the space features. The open-ended survey shows that rural residents are mostly satisfied with their current healthcare environment in terms of supporting patient-centered care, while other aspects still have room for future improvement.


Overall, this exploratory study identified important attributes of the physical environment that can support PCMH from rural residents' perspective.


patient experience; patient-centered medical home (PCMH); physical environment; rural health


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