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Factors Associated with Continuity of Care in the Medical Home for Medically Complex Children
Margo Fingeret1, Melissa S Stockwell2, Ronald Sanchez3
1Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NY, NY; NewYork-Presbyterian Hospital, NY, NY.
Insights
Older children with medical complexity (CMC) and those with inactive primary care providers (PCPs) experienced less continuity of care. Community health worker (CHW) support was found to be protective for CMC.
Area of Science:
- Pediatric Healthcare
- Health Services Research
- Complex Care Management
Background:
- Children with medical complexity (CMC) require coordinated care.
- Continuity of care in the patient-centered medical home (PCMH) is crucial for CMC.
- Factors influencing PCMH continuity for diverse, publicly insured urban populations are not well understood.
Purpose of the Study:
- To identify factors associated with continuity of care in the PCMH for CMC.
- To examine the role of social determinants of health (SDoH) and support services in PCMH continuity.
- To inform strategies for improving care coordination for vulnerable pediatric populations.
Main Methods:
- Retrospective chart review of 796 CMC (0-21 years) across 5 urban primary care practices.
- Continuity of care defined by periodicity schedule and ≥1 PCMH visit over six months.
- Analysis included demographics, PCP, SDoH, and involvement of community health workers (CHW), social workers (SW), and care managers; logistic regression used.
Main Results:
- 60% of CMC received timely care; 75% were Hispanic, 95% Medicaid-insured.
- Older age (≥6 years) and inactive primary care providers (PCPs) were associated with greater odds of lacking continuous care.
- Community health worker (CHW) support, ADHD diagnosis, Spanish-speaking caregiver, and specific PCMH site were protective factors; social worker (SW) involvement was not significant in the final model.
Conclusions:
- Older CMC and those with inactive PCPs face higher risks of disrupted care continuity.
- Community health worker (CHW) support demonstrates a protective effect, enhancing PCMH continuity for CMC.
- Targeted interventions, particularly CHW engagement, may improve care coordination for complex pediatric populations.
Objective:
This study explores factors associated with continuity of care in the patient-centered medical home (PCMH) for children with medical complexity (CMC) in 5 urban primary care practices caring for predominantly Latino, publicly insured children.
Methods:
A retrospective chart review from 9/2022-9/2024 was conducted for CMC aged 0-21 years with 4+ subspecialists or 2+ life sustaining devices. The primary outcome was continuity of care with the PCMH, defined by the periodicity schedule and ≥1 visit over a six-month period. Demographics, primary care provider (PCP), zip code, social determinants of health (SDoH), and involvement of a community health worker (CHW), social worker (SW), care manager were extracted. Chi-square identified factors associated with lack of continuity of care. Factors with a p<0.1 were included in a multivariable logistic regression model.
Results:
Of 796 CMC included, 60% received timely care; 74% were >6 years, 95% Medicaid-insured, 75% Hispanic, and 63% spoke English, 62% had an attending PCP, 38% had SW, 24% had CHW, and 20% a care manager. Significant associations with continuous care were only seen by age, PCMH, PCP, ADHD diagnosis, and SW and CHW involvement. On regression model, those ≥6 years and with an inactive PCP had greater odds of not being in continuous care. Having a CHW, ADHD, Spanish-speaking caregiver, or being a patient at one PCMH site was protective; SW involvement was no longer significant.
Conclusions:
Older CMC and those with inactive PCPs were more susceptible to a lack of continuous care. CHW support appeared protective.
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