The Value of the Medical Home for Children Without Special Health Care Needs

Abstract

Objective: Although the medical home is promoted by the American Academy of Pediatrics and the Affordable Care Act, its impact on children without special health care needs is unknown. We examined whether the medical home is associated with beneficial health care utilization and health-promoting behaviors in this population. Methods: This study was a secondary data analysis of the 2003 National Survey of Children’s Health. Data were available for 70 007 children without special health care needs. We operationalized the medical home according to the National Survey of Children’s Health design. Logistic regression for complex sample surveys was used to model each outcome with the medical home, controlling for sociodemographic characteristics. Results: Overall, 58.1% of children without special health care needs had a medical home. The medical home was significantly associated with increased preventive care visits (adjusted odds ratio [aOR]: 1.32 [95% confidence interval (CI): 1.22–1.43]), decreased outpatient sick visits (aOR: 0.71 [95% CI: 0.66–0.76), and decreased emergency department sick visits (aOR: 0.70 [95% CI: 0.65–0.76]). It was associated with increased odds of “excellent/very good” child health according to parental assessment (aOR: 1.29 [95% CI: 1.15–1.45) and health-promoting behaviors such as being read to daily (aOR: 1.46 [95% CI: 1.13–1.89]), reported helmet use (aOR: 1.18 [95% CI: 1.03–1.34]), and decreased screen time (aOR: 1.12 [95% CI: 1.02–1.22]). Conclusions: For children without special health care needs, the medical home is associated with improved health care utilization patterns, better parental assessment of child health, and increased adherence with health-promoting behaviors. These findings support the recommendations of the American Academy of Pediatrics and the Affordable Care Act to extend the medical home to all children.

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

“…A priori, we controlled for sociodemographic variables determined to be significant in previous work. 25 …”

“…The NSCH has associated the medical home with improved health care utilization patterns in both the emergency department and preventive care, 13,26 decreased unmet health needs, 26 and increased healthy activities. 27 Similar evidence garnered largely from other individual-level assessments in both the general pediatric population and more extensively in CSHCN 6,14 has led to the promotion of the medical home by a number of institutional and government organizations as an optimal model of primary care for all children.…”

“…In previous national studies using the NSCH method, 56% to 58% of the general pediatric population reported having a medical home. 12,25 Assuming a correlation between groups of 0.2 and equal cluster sizes, a power of 80%, and a significance level of 0.05, 6 clusters with a total sample size of 166 would be needed to detect a difference of 40% of an SD across comparison groups. We therefore recruited 180 subjects, 30 at each of the 6 sites.…”

“…[9][10][11] Recent studies in the general pediatric population have demonstrated similar positive associations with child health and health care utilization outcomes. [12][13][14] The medical home, in part based on this evidence, is now promoted by professional medical societies 15 and federal government agencies 16 as an optimal model for delivering primary care.…”

Early Intervention, IDEA Part C Services, and the Medical Home: Collaboration for Best Practice and Best Outcomes

“…Historically, the medical home was commonly discussed in the context of children with special health care needs, but increasingly, its value has been seen across the full spectrum of infants, children, and adolescents. [9][10][11] Clearly, the core components of care that define a medical home match closely those specified legislatively in IDEA Part C. As child find is mandated in Part C, there is recognition that the pediatric medical home is an integral part of that process. 11 Emerging evidence supports the medical home process regarding its value to children' s ultimate development and wellbeing.…”