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Relationship of Medical Home Components With Health Care Utilization and Unmet Needs in Children and Youth With
Suman Kanti Chowdhury1, Jennifer Marshall, Beth Boone
1Author Affiliations: Department of Community Health Sciences, University of South Florida College of Public Health, Tampa, Florida (Mr Chowdhury); Interdisciplinary Science Practice Strategic Area Lead, University of South Florida College of Public Health, Chiles Center, Tampa, Florida (Dr Marshall); Center for Autism and Related Disabilities at USF, College of Behavioral and Community Sciences, Center for Autism and Related Disabilities, Tampa, Florida (Dr Boone); and Department of Community Health Sciences, Distinguished University Professor and Marrell Endowed Chair, University of South Florida College of Public Health, Chiles Center, Tampa, Florida (Dr Kirby).
Background And Objective:
The medical home is a primary care model that offers comprehensive, uninterrupted, and family-centered care to children regardless of their special health care needs. Although the overall contribution of medical home is well-studied, the differential influence of its components on health care utilization and unmet needs, particularly for children and youth with special health care needs (CYSHCN) remains insufficiently understood. This study examined the medical home component(s) that can best predict emergency and preventive visits, and unmet needs in CYSHCN.
Methods:
This study analyzed 2016-2022 National Survey of Children's Health data from 64 553 caregivers of CYSHCN aged 0-17 years using the Rao-Scott Chi-square test and multivariable logistic regression.
Results:
Findings show that receiving care within an overall medical home was associated with lower odds of emergency visits [adjusted odds ratio (aOR): 0.77 (95% confidence interval: 0.70-0.84)] and unmet needs [aOR = 0.29 (0.24-0.34)], and higher odds of preventive dental visits [aOR = 1.40 (1.25-1.57)]. Having a usual source for sick care and receiving effective care coordination was associated with reduced odds of emergency visits (aOR = 0.74 [0.64-0.84] and aOR = 0.85 [0.77-0.95], respectively). Receiving family-centered care [aOR = 0.45 (0.38-0.54)], no problems getting needed referral [aOR = 0.58 (0.47-0.72)], and getting effective care coordination when needed [aOR = 0.32 (0.26-0.39)] were associated with lower odds of unmet needs. The odds of utilizing preventive medical and dental visits was higher with having a personal doctor or nurse [aOR = 1.42(1.12-1.80) and aOR = 1.41 (1.20-1.65), respectively] and receiving family-centered care [aOR = 1.59 (1.18-2.12) and aOR = 1.44 (1.22-1.71), respectively].
Conclusions:
The study highlights the importance of considering the differential contribution of medical home components for reducing emergency visits, addressing unmet needs, and improving preventive care, providing insights to enhance health care delivery for CYSHCN.
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