Association of Healthy Home Environments and Use of Patient-Centered Medical Homes by Children of Low-Income Families (original) (raw)
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Journal of Health Care for the Poor and Underserved, 2015
Purpose-Assess relationships between having a patient-centered medical home (PCMH) and health care utilization among low-income children with chronic conditions using parent and practice perspectives. Methods-We analyzed data from 240 publicly insured children with chronic conditions. Parents completed surveys assessing PCMH access and their child's primary care practice completed the Medical Home Index (MHI) self-assessment. Multivariate negative binomial analyses were conducted to investigate relationships between PCMH and service use. Results-Parent-report of a usual source of care was associated with lower rates of emergency care (ED) encounters and hospitalizations. Practice report of higher organizational capacity (e.g., communication, staff education) was associated with lower rates of ED visits and hospitalizations. Parent report of a PCMH was positively associated with practice MHI score.
Are Pediatric House Calls the Future? Exploring Patient Perceptions of Home-Centered Health
Clinical Pediatrics, 2019
Commentary the number of concierge medicine clinicians, who provide increased accessibility and services to a smaller panel of patients, grew from 2400 to 5000 practices in 2010 to 12 000 in 2014 and estimates as high as 20 000 currently. 3,4 Though concierge medicine may offer advantages to patients such as ease of access to physicians, unfortunately, considerable disparity exists in access to these services. Studies have found that compared with traditional primary care practices, the patient panels of concierge practices consist of fewer African American (7% vs 16%), Hispanic (4% vs 14%), and Medicaid (5% vs 15%) patients. 5 One strategy to address the provider shortage and increase access is to use nonphysician providers in home-based care models. Programs that utilize community health workers to provide in-home clinical services to lower socioeconomic populations have shown that low-cost, home-based interventions can avoid clinic and emergency department encounters at one tenth the cost of those visits. 6 Despite the growth of home-based clinical services, there has been no known assessment of patients' perceptions of these systems. Understanding these perceptions are key to the design of equitable models and the reduction of barriers to utilization. This study seeks to understand perceptions of home-based pediatric care among families of various socioeconomic strata. We hypothesized that perceptions of these services would vary based on different socioeconomic factors. Methods Study Sample Between March 2016 and October 2016, we conducted a cross-sectional survey of a convenience sample of families presenting for care at 2 pediatric primary care settings: (1) a clinic within a safety-net medical center serving primarily government-insured patients and (2) a private group practice serving a largely commercially insured population. At the safety-net medical center, the survey was administered via an in-person interview. At the private group practice, participants were given the survey to fill out on paper in the waiting room prior to their visit. Institutional review board approval was received at Boston Children's Hospital (IRB-P00022953) and Boston University School of Medicine (H-34478). No personal identifiers were collected with the survey responses. Data Survey. The survey consisted of items designed to measure parents' perception of the convenience of and comfort with in-home and clinic-based medical services for their children, as well as basic demographic descriptors, medical history, and recent health care utilization information. Ten-point Likert-type scales (1 = not convenient, 10 = very convenient) evaluated patient perception of convenience of in-home and clinic-based services for both well-child and sick visits. A 5-point Likert-type scale (1 = not comfortable, 5 = very 859869C PJXXX10.
Access to patient-centered medical home among Ohio’s Children with Special Health Care Needs
Journal of Child Health Care, 2012
Medical homes deliver primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate and culturally effective. Children with special health care needs (CSHCN) require a wide range of support to maintain health, making medical home access particularly important. We sought to understand independent risk factors for lacking access. We analyzed Ohio, USA data from the National Survey of Children with Special Health Care Needs (2005–2006). Among CSHCN, 55.6% had medical home access. The proportion achieving each medical home component was highest for having a personal doctor/nurse and lowest for receiving coordinated care, family-centered care and referrals. Specific subsets of CSHCN were significantly and independently more likely to lack medical home access: Hispanic (AOR=3.08), moderate/high severity of difficulty (AOR=2.84), and any public insurance (AOR=1.60). Efforts to advance medical home access must give special attention to these CSHCN p...
Academic Pediatrics, 2009
Objective.-The aim of this study was to determine whether having a medical home is associated with a reduction of racial/ ethnic disparities in emergency care utilization by children with special health care needs (CSHCN). Methods.-We conducted a secondary analysis of 35 301 children, aged 0 to 17, from the 2005-2006 National Survey of Children with Special Health Care Needs. The primary dependent variable was emergency care utilization, defined as 1 or more emergency care encounters in the last 12 months. The primary independent variables were race/ethnicity and type of care (medical home, usual source of care, no medical home/no usual source of care). Multiple logistic regression was conducted to investigate associations between race/ethnicity, type of care, and emergency care utilization.
Health services research, 2017
To examine: (1) what elements of patient-centered medical homes (PCMHs) are typically provided to low-income populations, (2) whether PCMHs improve health behaviors, experiences, and outcomes for low-income groups. Existing literature on PCMH utilization among health care organizations serving low-income populations. Systematic review and meta-analysis. We obtained papers through existing systematic and literature reviews and via PubMed, Web of Science, and the TRIP databases, which examined PCMHs serving low-income populations. A total of 434 studies were reviewed. Thirty-three articles met eligibility criteria. Patient-centered medical home interventions usually were composed of five of the six recommended components. Overall positive effect of PCMH interventions was d = 0.247 (range -0.965 to 1.42). PCMH patients had better clinical outcomes (d = 0.395), higher adherence (0.392), and lower utilization of emergency rooms (d = -0.248), but there were apparent limitations in study q...
Racial and Ethnic Disparities in Indicators of a Primary Care Medical Home for Children
Academic Pediatrics, 2009
Objective.-Racial/ethnic disparities in access to care across a broad range of health services have been well established. In adults, having a medical home has been shown to reduce disparities. The objective of this study was to assess the extent to which children of different race/ethnicities receive primary care consistent with a medical home. Methods.-We conducted a secondary analysis of 84 101 children, ages 0-17, from the 2003-2004 National Survey of Children's Health, a nationwide household survey. The primary independent variable was race/ethnicity of the child. The main dependent variable was a medical home as defined by the American Academy of Pediatrics. Multiple logistic regression was conducted to investigate associations between race/ethnicity and having a medical home.
Maternal and Child Health Journal, 2013
At some point in their lives, nearly one-half of all American children will have a behavioral health condition. Many will not receive the care they need from a fragmented health delivery system. The patient-centered medical home is a promising model to improve their care; however, little evidence exists. Our study aim was to examine the association between several behavioral health indicators and having a patient-centered medical home. 91,642 children's parents or guardians completed the 2007 National Survey of Children's Health. An indicator for patient-centered medical home was included in the dataset. Descriptive statistics, bivariate tests, and multivariate regression models were used in the analyses. Children in the sample were mostly Male (52 %), White (78 %), non-Hispanic (87 %), and did not have a special health care need (80 %). 6.2 % of the sample had at least one behavioral health condition. Conditions ranged from ADHD (6 %) to Autism Spectrum Disorder (ASD) (1 %). Frequency of having a patient-centered medical home also varied for children with a behavioral health condition (49 % of children with ADHD and 33 % of children with ASD). Frequency of having a patient-centered medical home decreased with multiple behavioral health conditions. Higher severity of depression, anxiety, and conduct disorder were associated with a decreased likelihood of a patient-centered medical home. Results from our study can be used to target patient-centered medical home interventions toward children with one or more behavioral health conditions and consider that children with depression, anxiety, and conduct disorder are more vulnerable to these disparities.