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Community health centers: medical homes for children?
Leesha K Hoilette1, Aaron K Blumkin, Constance D Baldwin
1Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.
Insights
Community health centers (CHCs) offer comparable family-centered, comprehensive, and compassionate care to other providers for low-income children. However, CHCs show lower accessibility ratings, highlighting areas for improvement in child healthcare delivery.
Area of Science:
- Pediatric Primary Care
- Health Services Research
- Health Equity
Background:
- Community Health Centers (CHCs) are vital for serving low-income populations, including children.
- Understanding the medical home attributes of CHCs is crucial for evaluating care quality for vulnerable children.
- Comparison with other providers for the poor is essential to identify strengths and weaknesses in care delivery.
Purpose of the Study:
- To compare the medical home attributes of Community Health Centers (CHCs) with other providers serving low-income children.
- To assess parental ratings of accessibility, family-centeredness, comprehensiveness, and compassionate care.
- To identify disparities in care experienced by children receiving services from CHCs versus other providers.
Main Methods:
- Cross-sectional study using Medical Expenditure Panel Survey (MEPS) data (2003-2009) for children aged 0-17 years.
- Analysis included families below 200% of the federal poverty level (FPL).
- Parental reports on four medical home attributes were compared between CHCs and other primary care settings, controlling for sociodemographic factors.
Main Results:
- CHCs serve a higher proportion of publicly insured/uninsured, minority, and less healthy children.
- Parental ratings for family-centered, comprehensive, and compassionate care were similar between CHCs and other providers (80-90%).
- CHCs received significantly lower ratings for accessibility (e.g., after-hours care, telephone access) by 10-18%.
Conclusions:
- CHCs provide comparable quality in certain aspects of care but face challenges in accessibility compared to other providers for low-income children.
- Racial/ethnic disparities in care exist in both settings and do not differ significantly between CHCs and other providers.
- Practice transformation strategies are needed to enhance accessibility and patient satisfaction in CHCs to improve child health outcomes.
Objective:
To explore medical home attributes of community health centers (CHCs) that provide care to low-income children nationwide compared to other providers for the poor.
Methods:
Cross-sectional study of children aged 0 to 17 years in the Medical Expenditure Panel Survey (MEPS; 2003 to 2009) who resided in families living at <200% of the federal poverty level (FPL) and had visits to a primary care setting. CHC visits were defined as a visit to a neighborhood/family health center, rural health clinic, or community health center. Independent measures included provider type, age, gender, race/ethnicity, insurance, FPL, number of parents at home, language, maternal education, health status, and special health care need. Dependent measures included 4 medical home attributes: accessibility, and family-centered, comprehensive, and compassionate care.
Results:
CHCs typically serve low-income children who are publicly insured or uninsured, come from racial/ethnic minority groups, and have poorer health status. Eighty percent to 90% of parents visiting both CHCs and other primary care providers rated high levels of family-centered, comprehensive, and compassionate care. However, CHCs had a 10% to 18% lower rating of accessibility (after-hours care, telephone access) even after controlling for sociodemographic characteristics. Racial/ethnic disparities existed at both settings, but these patterns did not differ between CHCs and other settings.
Conclusions:
On the basis of parental reports, CHCs received similar ratings to other primary care providers for family-centered, comprehensive, and compassionate care, but lower ratings for accessibility. Further studies should examine strategies for practice transformation in CHCs to improve patient satisfaction and accessibility to optimize child health outcomes.
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