Analyses Addresses the Extent to Which All Children Have a Medical Home

April 11, 2011

  http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-3555v1

"Receipt of care in medical homes is shown here to be associated with reduced access problems for medical and dental care," state the authors of an article published in Pediatrics online on March 14, 2011. The American Academy of Pediatrics (AAP) developed the medical home concept and has championed it for decades. Families, child health professionals, policymakers, and insurers endorse this model as a standard of care, and it now serves as a centerpiece for national quality-assurance measures. The article provides a population-based assessment of medical home access for all children using a comprehensive definition and describes the relationship between presence of a medical home and receipt of preventive medical and dental care. Dental care is included because experts and existing policy guidelines promote the integration of oral health services into the medical home.

Data for the analyses were drawn from the 2007 National Survey of Children's Health, a random-digit-dial population-based telephone survey of households with children from birth through age 17. (The parent or guardian served as the respondent for the interview.) The analyses were restricted to 83,448 children ages 1-17 who had valid data for all applicable components of the medical home. Presence of a medical home was computed for children according to demographic, social, and health-status variables. The impact of having a medical home was measured using variables intended to capture the spectrum of health care experiences associated with difficulty accessing medical and dental care and timely receipt of routine preventive medical and dental care. Predisposing variables included age, gender, race/ethnicity, primary language spoken at home, mother's educational attainment, perception of neighborhood safety, region, and urban/rural residence. Need variables included perceived health status. Enabling variables included household poverty status and the child's health insurance coverage status at the time of the interview.

The authors found that

• Nationally, 56.9 percent of children ages 1-17 had a medical home in 2007.
• Unmet medical care needs were reported for 3.7 percent of children.
  • The adjusted analysis showed that children without a medical home had almost four times the odds of having unmet medical care needs as children who had a medical home (6.4 percent vs. 1.6 percent).
• Overall, 11.7 percent of children did not receive a preventive medical care visit in the past year. Children without a medical home were more likely than children with a medical home to have gone without a preventive medical care visit (14.0 percent vs. 9.9 percent).
• The prevalence of unmet dental care needs was 2.9 percent for all children. Those without a medical home were three times more likely to have unmet dental care needs than those with a medical home (4.8 percent vs. 1.5 percent).

• Overall, 17.4 percent of children did not have a preventive dental care visit in the past year. On an unadjusted basis, children without a medical home were slightly more likely than those with a medical home to go without preventive dental care (16.6 percent vs. 18.4 percent); however, this relationship reversed in the adjusted analysis.

"Overall, slightly more than half of US children receive their care in medical homes," conclude the authors. They add, "given the presence of socioeconomic, racial/ethnic, and health disparities in receipt of care in medical homes, targeted initiatives addressing disadvantaged segments of the child population are needed."

Strickland BB, Jones JR, Ghandour RM, et al. 2011. The medical home: Health care access and impact for children and youth in the United States. Pediatrics [published online on March 14, 2011]. Abstract available at http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-3555v1.

 

 

Posted courtesy of the Maternal and Child Health Library.