Medical Home and Out-of-Pocket Medical Costs for Children With Special Health Care Needs

Porterfield, Shirley L.; DeRigne, LeaAnne

doi:10.1542/peds.2010-1307

Cited by 49 publications

(32 citation statements)

References 27 publications

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“…15 By definition, a medical home provides care coordination and other important functionalities. 19 Lack of a medical home has been associated with increased risk of forgone or delayed care among children 20 and, for families of CSHCN, increased outof-pocket health-related costs 21 and fewer referrals to needed specialty care. 12 Conversely, rates of visits to specialists have been demonstrated to decrease among CSHCN in medical homes.…”

Section: Discussionmentioning

confidence: 99%

“…However, consumer-based perception of quality and need of care are widely used measures of health care delivery. Although numerous publications define the medical home as we have done with the NS-CSHCN, 20,21,36,41,43,44 the items included to meet these criteria do not capture all activities of the medical home or care coordination (such as patient registries, team based care, comanagement arrangements with specialists, and other concepts of the patient-centered medical home). 45 However, the items used to define the constructs of the medical home and care coordination are aligned with the AAP definitions.…”

Section: Discussionmentioning

confidence: 99%

“…20,21,28,[31][32][33][34] This medical home measure uses the AAP definition of the medical home, representing 5 of 7 elements of the AAP criteria medical home criteria. The 5 component variables are constructed from a total of 22 NS-CSHCN survey items.…”

Section: Samplementioning

confidence: 99%

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Care Coordination and Unmet Specialty Care Among Children With Special Health Care Needs

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Parents of children with special health care needs and low-income children report more unmet specialty care needs. Care coordination is associated with increased and decreased referrals to specialty care, but whether care coordination is related to unmet needs is unknown.WHAT THIS STUDY ADDS: Among children with special health care needs, care coordination is associated with lower odds of unmet specialty care needs regardless of whether care coordination was received within a medical home. This association was independent of household income. abstract OBJECTIVES: Care coordination and the medical home may ensure access to specialty care. Children with special health care needs (CSHCN) have higher rates of specialty care use and unmet need compared with the general pediatric population. We hypothesized that care coordination, regardless of whether it was provided in a medical home, would decrease unmet specialty care needs among CSHCN and that the effect of care coordination would be greater among low-income families.METHODS: Secondary data analysis of participants in the 2009-2010 National Survey of CSHCN who reported unmet specialty care needs and for whom care coordination and medical home status could be determined (n = 18 905). Logistic regression models explored the association of unmet need with care coordination and medical home status adjusting for household income.RESULTS: Approximately 9% of CSHCN reported having unmet specialty care needs. Care coordination was associated with reduced odds of unmet specialty care need (without a medical home, odds ratio: 0.63, 95% confidence interval: 0.47-0.86; within a medical home, odds ratio: 0.22, 95% confidence interval: 0.16-0.29) with a greater reduction among those receiving care coordination within a medical home versus those receiving care coordination without a medical home. We did not find differences in the impact of care coordination by percentage of the federal poverty level. CONCLUSIONS:Care coordination is associated with family report of decreased unmet specialty care needs among CSHCN independent of household income. The effect of care coordination is greater when care is received in a medical home. Pediatrics

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Care Coordination and Unmet Specialty Care Among Children With Special Health Care Needs

et al. 2014

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“…For children with ADHD, the PCMH model has been associated with better adherence to recommended medications, improved school performance and interpersonal relationships, and decreased adverse events. 13 Some studies have suggested that for CSHCN, generally, families may incur fewer out-ofpocket costs if care is provided by a PCMH that includes effective care coordination 14 and is linked with well-organized community-based systems. 15 A medical home could not only help them with care coordination but also provide specific support services from coaching for behavior management to facilitated prescription refills.…”

mentioning

confidence: 99%

Patient-Centered Medical Home and Family Burden in Attention-Deficit Hyperactivity Disorder

Ronis

Baldwin

Blumkin

et al. 2015

Journal of Developmental &Amp; Behavioral Pediatrics

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“…Such studies have found the PCMH to be associated with increased utilization of primary care services 13 and decreased emergency care encounters, 14,15 family burden, 16 and out-of-pocket expenses. 17 …”

mentioning

confidence: 99%

Outcomes for Children with Chronic Conditions Associated with Parent- and Provider-reported Measures of the Medical Home

Raphael¹,

Cooley²,

Vega³

et al. 2015

hpu

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Purpose Assess relationships between having a patient-centered medical home (PCMH) and health care utilization among low-income children with chronic conditions using parent and practice perspectives. Methods We analyzed data from 240 publicly insured children with chronic conditions. Parents completed surveys assessing PCMH access and their child’s primary care practice completed the Medical Home Index (MHI) self-assessment. Multivariate negative binomial analyses were conducted to investigate relationships between PCMH and service use. Results Parent-report of a usual source of care was associated with lower rates of emergency care (ED) encounters and hospitalizations. Practice report of higher organizational capacity (e.g., communication, staff education) was associated with lower rates of ED visits and hospitalizations. Parent report of a PCMH was positively associated with practice MHI score. Conclusions Among low-income children with chronic conditions, having a usual source of care and higher quality organizational capacity were associated with lower rates of ED visits and hospitalizations.

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Medical Home and Out-of-Pocket Medical Costs for Children With Special Health Care Needs

Abstract: Families with CSHCN incur lower out-of-pocket medical costs when their children receive health care in a setting in which the care-coordination component of the medical home is in place.

Cited by 49 publications

References 27 publications

Care Coordination and Unmet Specialty Care Among Children With Special Health Care Needs

Care Coordination and Unmet Specialty Care Among Children With Special Health Care Needs

Patient-Centered Medical Home and Family Burden in Attention-Deficit Hyperactivity Disorder

Outcomes for Children with Chronic Conditions Associated with Parent- and Provider-reported Measures of the Medical Home

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