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Evaluating the Impact of Parent-Reported Medical Home Status on Children's Health Care Utilization, Expenditures, and
Bing Han1, Hao Yu2, Mark W Friedberg3,4,5
1RAND Corporation, Santa Monica, CA.
Insights
Losing a medical home can decrease health care quality and increase emergency room visits for children. Gaining a medical home may improve quality but does not significantly impact costs or utilization.
Area of Science:
- Pediatric Health Services Research
- Health Care Quality and Access
- Child Health Outcomes
Background:
- The medical home model aims to improve child healthcare delivery.
- Understanding the impact of medical home continuity is crucial for optimizing pediatric care.
- Previous research has explored various aspects of medical home models.
Purpose of the Study:
- To evaluate the effects of parent-reported medical home status on children's healthcare utilization, expenditures, and quality.
- To assess how changes in medical home status over time influence health outcomes.
- To provide evidence for the importance of stable medical home relationships in pediatrics.
Main Methods:
- Causal difference-in-differences approach using inverse probability weighting and doubly robust estimators.
- Analysis of Medical Expenditure Panel Survey (MEPS) data from 2004-2012, including 9,153 children followed for 2 years.
- Adjustment for sociodemographic, health, and insurance status, with sensitivity analyses performed.
Main Results:
- Children who lost their medical home showed significantly lower quality ratings and higher emergency care utilization.
- Children who gained a medical home had significantly higher quality ratings but no significant changes in expenditures or utilization.
- These findings highlight the differential impact of gaining versus losing a medical home.
Conclusions:
- Maintaining a medical home is associated with better healthcare quality for children.
- Losing a medical home may increase the likelihood of emergency care utilization.
- Ensuring continuity of medical home care is important for pediatric health outcomes.
Objective:
To evaluate the effects of the parent-reported medical home status on health care utilization, expenditures, and quality for children.
Data Sources:
Medical Expenditure Panel Survey (MEPS) during 2004-2012, including a total of 9,153 children who were followed up for 2 years in the survey.
Study Design:
We took a causal difference-in-differences approach using inverse probability weighting and doubly robust estimators to study how changes in medical home status over a 2-year period affected children's health care outcomes. Our analysis adjusted for children's sociodemographic, health, and insurance statuses. We conducted sensitivity analyses using alternative statistical methods, different approaches to outliers and missing data, and accounting for possible common-method biases.
Principal Findings:
Compared with children whose parents reported having medical homes in both years 1 and 2, those who had medical homes in year 1 but lost them in year 2 had significantly lower parent-reported ratings of health care quality and higher utilization of emergency care. Compared with children whose parents reported having no medical homes in both years, those who did not have medical homes in year 1 but gained them in year 2 had significantly higher ratings of health care quality, but no significant differences in health care expenditures and utilization.
Conclusions:
Having a medical home may help improve health care quality for children; losing a medical home may lead to higher utilization of emergency care.
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