A Comparison of Individual- Versus Practice-Level Measures of the Medical Home

Abstract

To determine the association between a widely used individual-level assessment of the medical home derived from parental perception and practice-level assessment of the medical home.METHODS: Thirty parents at each of 6 Boston-area community health centers (CHCs) were administered the 19-question medical home measure of the 2011 National Survey of Children's Health (NSCH). Each CHC was scored in accordance with the National Committee for Quality Assurance (NCQA) 2011 Patient-Centered Medical Home Standards and Guidelines. Bivariate analysis of the independent variables against the dependent variable (the NCQA measure, assessed as both a continuous score and a categorical tier) was performed. Linear and logistical regression models accounting for the cluster design were then constructed, with the NSCH measure as the primary predictor.RESULTS: Of the 180 parents, 52% had a medical home according to the NSCH criteria. Of the 6 CHCs, 5 were a medical home according to the NCQA Standards (2 at Tier 3, 3 at Tier 2). Regression modeling demonstrated nonsignificant associations between both the continuous and categorical (tier) NCQA scores and the NSCH assessment of the medical home, with a b of 22.80 (95% confidence interval, 27.75 to 13.35) and an adjusted odds ratio of 2.17 (95% confidence interval, 0.82 to 5.74), respectively.CONCLUSIONS: There was no significant association between the individual-level and practice-level assessments of the medical home. Given this discrepancy, our results suggest that we may need to temper our expectations that the medical home transformation currently being implemented at the practice level will lead to the child health and health care utilization outcomes extensively demonstrated in the literature.

Immigrant Families, Children With Special Health Care Needs, and the Medical Home

“…Our categories of immigrant family types are consistent with US Census Bureau definitions for household generational status. 33 The medical home variable definition is replicated in other large datasets of children's health in the United States, although the association of the parent-reported medical home variable in the NSCH to practice designated medical homes is not well described. 34 As with most observational studies, it is not possible to draw causal inferences.…”

Evaluating the Impact of Parent‐Reported Medical Home Status on Children's Health Care Utilization, Expenditures, and Quality: A Difference‐in‐Differences Analysis with Causal Inference Methods

“…Second, the finding that quality improvements are concurrent with gaining a parent‐reported medical home suggests that policies that encourage children to have medical homes (through either patient‐facing strategies such as value‐based insurance design or provider‐facing strategies such as incentives to provide medical home services) may be valuable. However, discrepancies exist in the definition of a medical home, depending on individual‐level and practice‐level assessments of this status (Long and Garg ). Finding the optimal mix of patient‐ and provider‐facing strategies is a high priority for our health system and a fertile area for future research.…”