Medical Home and Emergency Department Utilization Among Children With Special Health Care Needs

ArticleinThe Journal of ambulatory care management 35(3):238-46 · July 2012with7 Reads
DOI: 10.1097/JAC.0b013e318249c5ca · Source: PubMed
The purpose of this article was to determine whether medical home associated with reduction in emergency department utilization by children with special health care needs. The study comprised 40 723 children participating in the National Survey of Children with Special Health Care Needs. For whole sample, presence of medical home was not associated with a decrease in emergency department (ED) utilization. However, children aged 0 to 5 years and those with severe functional limitations derived the most benefit from a medical home. Presence of medical home for severely limited children was associated with fewer ED visits (odds ratio, 0.59; 95% confidence interval, 0.50-0.70). Additional studies are warranted to explore specific components of a medical home and ED use.
  • [Show abstract] [Hide abstract] ABSTRACT: This study assesses the health care costs and utilization among labor union members from 2008 to 2010 and compares whether members accessing primary care providers participating in a public health city program, the Primary Care Information Project (PCIP), had different health care usage or cost patterns. Using claims data, the number of hospital inpatient services utilized decreased by 16 per 100 members among those with chronic conditions accessing PCIP providers, whereas members seeing non-PCIP providers increased by 15 per 100 members. Access to providers participating in a population health initiative was associated with lower utilization of inpatient services and overall costs.
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  • [Show abstract] [Hide abstract] ABSTRACT: The Patient-Centered Medical Home (PCMH) is a model of care that has been promoted as a way to transform a broken primary care system in the US. However, in order to convince more practices to make the transformation and to properly reimburse practices who are PCMHs, valid and reliable data are needed. Data that capture patient experiences in a PCMH is valuable, but which instrument should be used remains unclear. Our study aims to compare the validity and reliability of two national PCMH instruments. Telephone surveys were conducted with children who receive care from 20 pediatric practices across Florida (n = 990). All of the children are eligible for Medicaid or the Children's Health Insurance Program. Analyses were conducted to compare the Consumer Assessment of Health Plan Survey-Patient-Centered Medical Home (CAHPS-PCMH) and the National Survey of Children with Special Health Care Needs (NS-CSHCN) medical home domain. Respondents were mainly White non-Hispanic, female, under 35 years old, and from a two-parent household. The NS-CSHCN outperformed the CAHPS-PCMH in regard to scale reliability (Cronbach's alpha coefficients all ≥0.81 vs. 0.56-0.85, respectively). In regard to item-domain convergence and discriminant validity the CAHPS-PCMH fared better than the NS-CSHCN (range of convergence 0.66-0.93 vs. 0.32-1.00). The CAHPS-PCMH did not correspond to the scale structure in construct validity testing. Neither instrument performed well in the known-groups validity tests. No clear best instrument was determined. Further revision and calibration may be needed to accurately assess patient experiences in the PCMH.
    Article · Mar 2014
  • [Show abstract] [Hide abstract] ABSTRACT: 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. Conclusions: Among low-income children with chronic conditions, having a usual source of care and higher quality organizational capacity were associated with lower rates of ED visits and hospitalizations.
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