Association of Care in a Medical Home and Health Care Utilization Among Children with Sickle Cell Disease

Abstract

Objective-Sickle cell disease (SCD) is marked by high utilization of medical services. The aim of this study was to determine whether having a patient-centered medical home (PCMH) is associated with a reduction in emergency care (ED) utilization or hospitalizations among children with scd. Methods-We collected and analyzed data from parents of 150 children, ages 1 to 17 years, who received care within a large children's hospital. The primary dependent variables were rates of parent-reported ED visits and hospitalizations. The principal independent variable was parentreported experience with an overall PCMH or its four individual components (regular provider, comprehensive care, family-centered care, and coordinated care). Multivariate negative binomial regression, yielding incident rate ratios (irr), was used for analysis. Results-Children who received comprehensive care had half the rate of ED visits (IRR 0.51, 95% confidence interval, 0.33-0.78) and nearly half the rate of hospitalizations (IRR 0.56, 95% confidence interval, 0.33-0.93) compared to children without comprehensive care. No other component of the PCMH was significantly associated with ED visits or hospitalizations. Children reported to have excellent/very good/good health status had lower odds of ED visits and hospitalizations compared to those reported to be in fair/poor condition. Conclusions-Children with SCD reported to experience comprehensive care had lower rates of ED encounters and hospitalizations after controlling for demographics and health status. The overall findings highlight that the provision of comprehensive care-having a usual source of care and no problems with referrals-may provide a strategy for improving pediatric SCD care.

Barriers to care and quality of primary care services in children with sickle cell disease

“…, Raphael et al . ). Given these identified gaps in access to primary care services, it is important to determine if there are particular healthcare barriers that cluster in SCD populations and prevent optimal treatment in the primary care setting.…”

“…Using data from a large national survey, Raphael and colleagues (2013) estimated that only two‐thirds of children with SCD receive comprehensive care and only 20% experience effective care coordination between their primary care and specialist providers. Boulet and colleagues () found that children with SCD experienced more limited access to care (e.g.…”

From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

“…Under comprehensive care there were fewer ED contacts (incidence rate ratio 0.51, 95% confidence interval 0.33 to 0.78) and a lower hospitalisation rate. Without directly comparing it with comprehensive care, this study 130 also reported that 'co-ordinated care' (defined as a provider sharing information and communicating effectively with child, family and consultants, as well as linking to community resources) did not have either effect.…”

“…Taken together, the two relevant studies 130,131 in our review were both equivocal about whether or not demand management systems (as opposed to individual care plans; see Care planning for individual patients) diverted patients away from hospital and into primary care.…”

“…One cross-sectional study in the USA, 130 which used a convenience sample (n = 150), compared 'comprehensive care' (i.e. one physician managing both the primary and tertiary health-care needs of a child: a form of gatekeeping) with usual services.…”