Health Care Use and Expenditures Associated With Access to the Medical Home for Children and Youth

Romaire, Melissa; Bell, Janice F.; Grossman, David C.

doi:10.1097/mlr.0b013e318244d345

Cited by 35 publications

(33 citation statements)

References 28 publications

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“…Although overall ED use in our study population was slightly higher than that found in other nationally representative samples of children, it was in the same range. 25,26 Future work is needed to assess the potentially variable effects of enhanced access on non-urgent ED use in general populations and in populations that have higher ED use, such as children with special health care needs and publicly insured children. Our finding of decreased ED use with extended hours for publicly insured children but not for CSHCN suggests that enhanced access alone may not address the complex needs of CHSCN but could mitigate barriers for low-income families with generally well children.…”

Section: Discussionmentioning

confidence: 99%

Association between Enhanced Access Services in Pediatric Primary Care and Utilization of Emergency Departments: A National Parent Survey

Zickafoose

DeCamp

Prosser

2013

The Journal of Pediatrics

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Objectives To measure the prevalence of enhanced access services in pediatric primary care and to assess whether enhanced access services are associated with lower emergency department (ED) utilization. Study design Internet-based survey of a national sample of parents (n=820, response rate 41%). We estimated the prevalence of reported enhanced access services and ED use in the prior 12 months. We then used multivariate negative binomial regression to assess associations between enhanced access services and ED use. Results The majority of parents reported access to advice by telephone during office hours (80%), same-day sick visits (79%), and advice by telephone outside office hours (54%). Fewer than one-half of parents reported access to their child’s primary care office on weekends (47%), after 5:00 pm on any night (23%), or by email (13%). Substantial proportions of parents reported that they did not know if these services were available (7-56%, depending on service). Office hours after 5:00 pm on ≥5 nights a week was the only service significantly associated with ED utilization in multivariate analysis (adjusted incidence rate ratio: 0.51 [95% CI 0.28-0.92]). Conclusions The majority of parents report enhanced access to their child’s primary care office during office hours, but many parents do not have access or do not know if they have access outside of regular office hours. Extended office hours may be the most effective practice change to reduce emergency department use. Primary care practices should prioritize the most effective enhanced access services and communicate existing services to families.

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Section: Discussionmentioning

confidence: 99%

Association between Enhanced Access Services in Pediatric Primary Care and Utilization of Emergency Departments: A National Parent Survey

Zickafoose

DeCamp

Prosser

2013

The Journal of Pediatrics

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“…Although their results appear to conflict with our findings that costs were not a reason for unmet need among CSHCN lacking a medical home, the two studies address different concepts: Our work concerns parents’ perceptions of why they chose not to obtain needed health services for their children, while Porterfield and DeRigne analyzed reported out-of-pocket expenditures on health services for those who did obtain those services. In the general pediatric population, Romaire et al found that higher expenditures for prescription medications, outpatient and dental care were offset by lower expenditures for other types of care, with the result that total expenditures were the same for children with medical homes and those without [25]. …”

Section: Discussionmentioning

confidence: 99%

“…Medical homes are associated with less unmet need among CSHCN, among children with disabilities [20-24] , and among U.S. children generally [25]. Lacking such help, the families of CSHCN without medical homes may have problems identifying health care providers who meet their child's needs and coordinating services among multiple providers, contributing to their unmet needs for care.…”

Section: Introductionmentioning

confidence: 99%

Reasons for Unmet Need for Child and Family Health Services among Children with Special Health Care Needs with and without Medical Homes

et al. 2013

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ObjectivesMedical homes, an important component of U.S. health reform, were first developed to help families of children with special health care needs (CSHCN) find and coordinate services, and reduce their children’s unmet need for health services. We hypothesize that CSHCN lacking medical homes are more likely than those with medical homes to report health system delivery or coverage problems as the specific reasons for unmet need. MethodsData are from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN), a national, population-based survey of 40,723 CSHCN. We studied whether lacking a medical home was associated with 9 specific reasons for unmet need for 11 types of medical services, controlling for health insurance, child’s health, and sociodemographic characteristics. ResultsWeighted to the national population, 17% of CSHCN reported at least one unmet health service need in the previous year. CSHCN without medical homes were 2 to 3 times as likely to report unmet need for child or family health services, and more likely to report no referral (OR= 3.3), dissatisfaction with provider (OR=2.5), service not available in area (OR= 2.1), can’t find provider who accepts insurance (OR=1.8), and health plan problems (OR=1.4) as reasons for unmet need (all p<0.05). ConclusionsCSHCN without medical homes were more likely than those with medical homes to report health system delivery or coverage reasons for unmet child health service needs. Attributable risk estimates suggest that if the 50% of CSHCN who lacked medical homes had one, overall unmet need for child health services could be reduced by as much as 35% and unmet need for family health services by 40%.

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“…[23][24][25][26] Importantly, studies suggest that if savings do emerge, they are likely to come from reductions in emergency department visits or hospitalizations 23,25 and thus will not financially benefit primary care practices un- less financial incentives or risk-based payment models are in place. However, our participants acknowledged that several of the newly implemented activities were critical to improving care quality and were thankful that the application process drove their organizations to understand the need to dedicate time and resources to make these advancements.…”

Section: Discussionmentioning

confidence: 99%

The Cost to Successfully Apply for Level 3 Medical Home Recognition

Halladay

Mottus

Reiter

et al. 2016

The Journal of the American Board of Family Medicine

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Background:The National Committee for Quality Assurance patient-centered medical home recognition program provides practices an opportunity to implement medical home activities. Understanding the costs to apply for recognition may enable practices to plan their work.Methods: Practice coaches identified 5 exemplar practices (3 pediatric and 2 family medicine practices) that received level 3 recognition. This analysis focuses on 4 that received recognition in 2011. Clinical, informatics, and administrative staff participated in 2-to 3-hour interviews. We determined the time required to develop, implement, and maintain required activities. We categorized costs as (1) nonpersonnel, (2) developmental, (3) those used to implement activities, (4) those used to maintain activities, (5) those to document the work, and (6) consultant costs. Only incremental costs were included and are presented as costs per full-time equivalent (pFTE) provider.Results: Practice size ranged from 2.5 to 10.5 pFTE providers, and payer mixes ranged from 7% to 43% Medicaid. There was variation in the distribution of costs by activity by practice, but the costs to apply were remarkably similar ($11,453-15,977 pFTE provider).

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Health Care Use and Expenditures Associated With Access to the Medical Home for Children and Youth

Abstract: The medical home is associated with several domains of health service use, yet there is no evidence for its association with health care expenditures for children and youth.

Cited by 35 publications

References 28 publications

Association between Enhanced Access Services in Pediatric Primary Care and Utilization of Emergency Departments: A National Parent Survey

Association between Enhanced Access Services in Pediatric Primary Care and Utilization of Emergency Departments: A National Parent Survey

Reasons for Unmet Need for Child and Family Health Services among Children with Special Health Care Needs with and without Medical Homes

The Cost to Successfully Apply for Level 3 Medical Home Recognition

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