Receipt of patient-centered medical home and associated substance use disorder among adolescents: A propensity score analysis

Substance use disorder (SUD) is a major public health concern among U.S. adolescents. The patient-centered medical home (PCMH), emphasizing coordinated, comprehensive, and continuous primary care tailored to patient needs, has emerged as a promising model for integrating behavioral health. Yet, little is known about its association with adolescent SUD. This study examined the relationship between PCMH receipt and SUD among adolescents (N = 30,629; ages 10–17) from the combined 2018–2019 National Survey of Children’s Health. Propensity score matching using a 1:1 nearest neighbor algorithm was applied to reduce potential selection bias between adolescents who reported receipt of PCMH and those who did not. A weighted logistic regression was conducted in the matched sample, adjusting for covariates guided by the Andersen Model of Healthcare Utilization. A balanced matched sample containing 25,576 participants was achieved (imbalance test: χ2 = 7.09, d.f. = 6, p = 0.312), suggesting that potential selection bias was reduced. Adolescents reporting PCMH receipt had significantly lower odds of current SUD status (OR = 0.46, p < 0.01). Findings highlight the behavioral health benefits of PCMH and its relevance for early SUD prevention. Primary care providers may play a crucial role through screening and coordinated care. Efforts to address implementation barriers are warranted to improve adolescent behavioral health outcomes.