Urban Rural Differences on Accessing Patient- Centered Medical Home Among Children With Mental/Developmental Health...

Area of Science:

• Health Services Research
• Pediatric Health
• Public Health

Background:

• Patient-centered medical homes (PCMHs) are increasingly adopted in the US to manage healthcare costs and improve primary care coordination.
• Understanding urban-rural disparities in PCMH access is crucial, especially for children with complex health needs like developmental disabilities (DDs) and mental health disorders (MHDs).

Purpose of the Study:

• To examine urban-rural differences in accessing PCMHs among US children.
• To specifically investigate these differences for children with DDs and/or MHDs.

Main Methods:

• Cross-sectional study utilizing the 2016-2018 National Survey for Children's Health (NSCH).
• Multivariable adjusted logistic regression analyses were employed to assess associations between PCMH access, rurality, and mental/developmental conditions.

Main Results:

• Children with both DDs and MHDs were more prevalent in rural areas (10.9% vs. 8.3%).
• While overall rural children showed higher PCMH access (14%), this trend did not hold for subgroups with DDs/MHDs.
• Children with both DDs and MHDs faced a 41% reduction in PCMH access compared to those without these conditions.

Conclusions:

• PCMH quality improvement efforts should prioritize family-centered care, care coordination, and referrals, particularly for vulnerable populations.
• Performance measurement for PCMHs needs enhancement to better capture mental health integration and geographical variations in care access.