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National Trends in Indicators of a Medical Home for Children
Gregory D Stevens1, Alice Y Kim2
1Departments of Family Medicine and Preventive Medicine, Keck School of Medicine, University of Southern California, Alhambra, CA, USA.
Insights
Primary care for children shows some improvement in alignment with the patient-centered medical home model. However, vulnerable children experienced more significant fluctuations, highlighting a need for targeted support.
Area of Science:
- Pediatrics
- Health Services Research
- Primary Care
Background:
- The patient-centered medical home (PCMH) model is widely recognized for enhancing primary care quality.
- Understanding trends in PCMH adoption and its impact on children's healthcare experiences is crucial.
Purpose of the Study:
- To assess national trends in children's primary care alignment with the PCMH model.
- To investigate how these trends differ for vulnerable children based on social and demographic risk factors.
Main Methods:
- Analysis of data from 289,672 children (0-17 years) using the National Survey of Children's Health (2003, 2007, 2011-2012).
- Evaluation of PCMH indicators: access, continuity, comprehensiveness, and family-centeredness.
- Comparison of national trends with those for children facing social and demographic risks.
Main Results:
- Overall improvements observed in medical home scores, access, and continuity from 2003 to 2012.
- Declines noted in comprehensiveness and family-centered care indicators during the same period.
- Children with higher risk factors exhibited greater fluctuations in PCMH measures over time.
Conclusions:
- Children's primary care experiences show improved, albeit non-linear, alignment with the PCMH model.
- Improvements were not consistent across all PCMH components.
- Vulnerable children experienced more volatile changes, indicating a need for focused interventions to ensure equitable primary care access and quality.
Objectives:
The patient centered medical home is now widely supported as a strategy for delivering high quality primary care. The objective of this study was to examine whether children's primary care experiences nationally have become more aligned with the medical home model over time, and how this may have varied for vulnerable children.
Methods:
This study analyzed data on 289,672 children, aged 0-17 years, of families responding to one of three iterations of National Survey of Children's Health from 2003, 2007 and 2011-2012. Each year, we assessed indicators of four medical home features (access, continuity, comprehensiveness, and family-centeredness) and a total medical home score for children nationally and for those with a set of social and demographic risk factors.
Results:
Indicators of access and continuity, and total medical home scores fluctuated but improved overall from 2003 to 2012 (7.1, 6.7 and 1.4 % point increases, respectively), while indicators of comprehensiveness and family-centered care measures declined (2.4 and 1.8 % point decreases, respectively). Children with the highest levels of social and demographic risk experienced larger fluctuations in these measures over time.
Conclusions For Practice:
There were improvements in the extent to which children's primary care experiences aligned with a medical home model, though not linearly or for all component features. Children with more risk factors experienced more volatile changes, suggesting a particular need to attend to the primary care experiences of the most vulnerable children.
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