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Hamdan SZ, Bennett A. Autism-Friendly Healthcare: A Narrative Review of the Literature. Cureus 2024; 16:e64108. [PMID: 39114203 PMCID: PMC11305600 DOI: 10.7759/cureus.64108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
Disparities in healthcare access, delivery, and outcomes exist between autistic and non-autistic individuals. Autism-friendly healthcare initiatives aim to facilitate and improve the healthcare experience of autistic individuals by addressing commonly encountered challenges. While there is no consensus regarding the definition of autism-friendly healthcare, in this narrative review, we examine previously published research to determine the most important components of autism-friendly healthcare. Patient-related factors, provider-related factors, and system-related factors should be addressed. Proactivity, flexibility, and collaboration should guide the process of transforming the healthcare system. Finally, multiple strategies can be utilized as appropriate to the setting and individuals.
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Affiliation(s)
- Samar Z Hamdan
- Department of Pediatrics, College of Medicine and Surgery, King Abdulaziz University, Jeddah, SAU
| | - Amanda Bennett
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
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Rajan M, Pinheiro LC, Abramson EL, Kern LM. Adverse Social Determinants of Health and Gaps in Care Coordination Among Children. J Ambul Care Manage 2024; 47:3-13. [PMID: 37994509 DOI: 10.1097/jac.0000000000000481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Gaps in care coordination (CC) can have detrimental impacts on children's health. It is unclear how much adverse social determinants of health (SDoH) may affect CC gaps. We determined whether exposure to adverse SDoH is associated with experiencing more gaps in CC using a representative national sample of children. Children with inadequate or no health insurance (adjusted odds ratio [aOR] = 2.41; 95% confidence interval [CI], 2.19-2.66) and living in disadvantaged neighborhoods (aOR = 1.53; 95% CI, 1.33-1.75) have a higher likelihood of having gaps in CC, as do those with higher counts of adverse SDoH (aOR = 2.17; 95% CI, 1.85-2.53). Thus, interventions to improve CC for children should consider adverse SDoH.
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Santibanez TA, Black CL, Vogt TM, Chatham-Stephens K, Zhou T, Lendon JP, Singleton JA. Where are children ages 5-17 years receiving their COVID-19 vaccinations? Variations over time and by sociodemographic characteristics, United States. Vaccine 2022; 40:6917-6923. [PMID: 36280560 PMCID: PMC9581793 DOI: 10.1016/j.vaccine.2022.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Knowing the settings where children ages 5-17 years received COVID-19 vaccination in the United States, and how settings changed over time and varied by socio-demographics, is of interest for planning and implementing vaccination programs. METHODS Data from the National Immunization Survey-Child COVID-19 Module (NIS-CCM) were analyzed to assess place of COVID-19 vaccination among vaccinated children ages 5-17 years. Interviews from July 2021 thru May 2022 were included in the analyses for a total of n = 39,286 vaccinated children. The percentage of children receiving their COVID-19 vaccine at each type of setting was calculated overall, by sociodemographic characteristics, and by month of receipt of COVID-19 vaccine. RESULTS Among vaccinated children ages 5-11 years, 46.9 % were vaccinated at a medical place, 37.1 % at a pharmacy, 8.1 % at a school, 4.7 % at a mass vaccination site, and 3.2 % at some other non-medical place. Among vaccinated children ages 12-17 years, 35.1 % were vaccinated at a medical place, 47.9 % at a pharmacy, 8.3 % at a mass vaccination site, 4.8 % at a school, and 4.0 % at some other non-medical place. The place varied by time among children ages 12-17 years but minimally for children ages 5-11 years. There was variability in the place of COVID-19 vaccination by age, race/ethnicity, health insurance, urbanicity, and region. CONCLUSION Children ages 5-17 years predominantly received their COVID-19 vaccinations at pharmacies and medical places. The large proportion of vaccinated children receiving vaccination at pharmacies is indicative of the success in the United States of expanding the available settings where children could be vaccinated. Medical places continue to play a large role in vaccinating children, especially younger children, and should continue to stock COVID-19 vaccine to keep it available for those who are not yet vaccinated, including the newly recommended group of children < 5 years.
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Affiliation(s)
- Tammy A. Santibanez
- National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA 30329, USA,Corresponding author at: National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, NE Atlanta, GA, USA
| | - Carla L. Black
- National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA 30329, USA
| | - Tara M. Vogt
- National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA 30329, USA
| | - Kevin Chatham-Stephens
- National Center on Birth Defects and Developmental Disabilities (NCBDDD), Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, NE Atlanta, GA 30329, USA
| | - Tianyi Zhou
- National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA 30329, USA,Leidos Inc., 2295 Parklake Drive, NE Atlanta, GA 30345, USA
| | - Jessica P. Lendon
- National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), 3311 Toledo Road, Hyattsville, MD 20782, USA
| | - James A. Singleton
- National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA 30329, USA
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Han B, Chen PGC, Yu H. Access to after-hours primary care: a key determinant of children's medical home status. BMC Health Serv Res 2021; 21:185. [PMID: 33639929 PMCID: PMC7913420 DOI: 10.1186/s12913-021-06192-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The medical home (MH) model has been promoted by both the federal and state governments in the United States in recent years. To ascertain American children's MH status, many studies have relied on a large set of survey items, posing a considerable burden on their parents. We aimed to identify individual survey items or domains that best predict MH status for children and use them to develop brief markers of MH status. We also examined whether the identified items differed by status of special health care needs and by racial/ethnic group. METHOD Using the 9-year data from Medical Expenditure Panel Survey, we examined associations between children's MH status and individual survey items or domains. We randomly split the data into two halves with the first half (training sample, n = 8611) used to identify promising items, and the second half (validation sample, n = 8779) used to calculate all statistical measures. After discovering significant predictors of children's MH status, we incorporated them into several brief markers of MH status. We also conducted stratified analyses by status of special health care needs and by racial/ethnic group. RESULTS Less than half (48.7%) of the 8779 study children had a MH. The accessibility domain has stronger association with children's MH status (specificity = 0.84, sensitivity = 1, Kappa = 0.83) than other domains. The top two items with the strongest association with MH status asked about after-hours primary care access, including doctors' office hours at night or on the weekend and children's difficulty accessing care after hours. Both belong to the accessibility domain and are one of several reliable markers for children's MH status. While each of the two items did not differ significantly by status of special health care needs, there were considerable disparities across racial/ethnic groups with Latino children lagging behind other children. CONCLUSION Accessibility, especially the ability to access health care after regular office hours, appears to be the major predictor of having a MH among children. The ongoing efforts to promote the MH model need to target improving accessibility of health care after regular hours for children overall and especially for Latino children.
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Affiliation(s)
- Bing Han
- Health Unit, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Peggy Guey-Chi Chen
- Health Unit, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Hao Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA.
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The Compounding Effect of Race/Ethnicity and Disability Status on Children's Health and Health Care by Geography in the United States. Med Care 2020; 58:1059-1068. [PMID: 33177369 DOI: 10.1097/mlr.0000000000001428] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to examine the potential compounding effect of race/ethnicity, and disability status on children's health and health care, stratified by selected geographies. METHODS We used the 2011/2012 NSCH and the 2012 Boston Survey of Children's Health for our compounded disparity analysis. We used VanderWheel and Knol method to first predict combined risk ratios of race/ethnicity and disability and then compared them with the observed combined risk ratios. RESULTS We demonstrated that racial/ethnic minority children with disabilities experience additional disparities in health care access outcomes that are greater than the sum of the effects from either characteristic alone. Further, we demonstrate that disparities persist across all selected geographies irrespective of whether children lived in states or metropolitan cities with the best health care systems in the United States. CONCLUSIONS Despite reform efforts, our study demonstrates that racial/ethnic minority children with disabilities experience a double burden. Given the deleterious compounded disparities, public health and social service programs at all geographical levels should prioritize identifying participants that face this and tailor programs to meet their needs.
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Abstract
OBJECTIVES Medical homes are an effective model of primary care. Historically, however, racial and ethnic minorities have not had equal access to medical homes. The present study estimated the national prevalence of youth's access to a medical home and its components by race and ethnicity. METHODS We conducted secondary data analysis using the 2016-2017 National Survey of Children's Health, a nationally representative, cross-sectional survey of U.S. youth age 0-17 years (N = 62,308). We obtained weighted and unweighted descriptive statistics and conducted multivariate logit regression models. RESULTS Although 49% of the total sample had access to a medical home, 57.1% of white youth had access compared to 37% of Hispanic youth and 39.7% of black youth. Among youth without a medical home, black youth had less access than white youth to a usual place for care (64.7% vs. 55.3%, adjusted odds ratio [aOR] = 0.82, 95% confidence interval [CI] 0.69-0.97) and family-centered care (78.1% vs. 66.7%, aOR = 0.64, 95% CI 0.52-0.79). Hispanic youth (68.2%) also had less access to family-centered care than white youth (aOR = 0.73, 95% CI 0.60-0.89). White youth were less likely to have access to effective care coordination, when needed, than Hispanic youth (46.2% vs. 53.5%, aOR = 1.35, 95% CI 1.09-1.66). CONCLUSIONS FOR PRACTICE Our findings suggest racial/ethnic disparities exist in youth's access to a medical home and its components. We posit the need for continued efforts to enhance access to medical homes for all youth. Future studies need to examine systemic barriers to youth's access to medical homes.
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Baker S, Morawska A, Mitchell AE. Do Australian children carry out recommended preventive child health behaviours? Insights from an online parent survey. J Paediatr Child Health 2020; 56:900-907. [PMID: 31951073 DOI: 10.1111/jpc.14773] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 12/17/2019] [Accepted: 12/22/2019] [Indexed: 12/26/2022]
Abstract
AIM To investigate (i) the proportion of Australian children who do not adhere to preventive child health behaviours, (ii) clustering of child health behaviours, (iii) the proportion of parents who are concerned about not meeting recommendations and (iv) parents' access to and interest in information on ways to establish healthy habits in their child. METHODS A cross-sectional online survey of 477 Australian parents of 0-4-year-old children assessed the degree to which children meet key child health recommendations (diet, physical activity, oral health, sleep, pedestrian/vehicle safety, screen use, sun safety, personal hygiene, medical care), examined clustering of health behaviours and identified parents' greatest concerns. RESULTS A significant proportion of children do not meet recommendations for many preventive child health behaviours. More than half of the parents report infrequent toothbrushing and dentist check-ups, less than the recommended vegetable consumption, excessive consumption of treats, not wearing safety equipment, excessive screen time and screen time during meals, child inactivity, insufficient sleep, not covering coughs and sneezes, insufficient hand and nail hygiene and inadequate sun protection. No clustering of life-style risk behaviours was found. Areas of greatest concern to parents are vegetable consumption, toothbrushing, covering coughs and sneezes, screen time and wearing sunglasses. CONCLUSIONS While the majority of Australian parents have accessed child health recommendations, relatively few consistently implement health-protective practices with their children. Parents are concerned about this and interested in receiving information. Future research should investigate barriers to following guidelines and how parents can best be supported in establishing healthy habits.
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Affiliation(s)
- Sabine Baker
- Parenting and Family Support Centre, School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Alina Morawska
- Parenting and Family Support Centre, School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Amy E Mitchell
- Parenting and Family Support Centre, School of Psychology, University of Queensland, Brisbane, Queensland, Australia
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Impact of Medical Home on Health Care of Children With and Without Special Health Care Needs: Update from the 2016 National Survey of Children's Health. Matern Child Health J 2020; 23:1500-1507. [PMID: 31222602 DOI: 10.1007/s10995-019-02774-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective The medical home has been promoted as an optimal model of health care delivery for children. The purpose of this study was to examine the association between having access to a medical home and the health care experiences of children with and without special health care needs (SHCN) in the United States. Methods We analyzed data from the 2016 National Survey of Children's Health. We modeled logistic regressions to assess associations of having access to a medical home with health care experiences for 11,392 CSHCN and 38,820 non-CSHCN. Results We found that not having access to a medical home was negatively associated with preventive medical and dental care visits, greater unmet medical and dental needs, and hospital emergency room visits. Additionally, not having access to a medical home was negatively associated with the physical and oral health among CSHCN and oral health among non-CSHCN. However, we found no significant association between improved physical health status and having access to a medical home among non-CSHCN. Conclusions Results from our analysis suggest that having access to a medical home remains key determinant of improved health care experiences by CSHCN and non-CSHCN in the United States. Our findings underscore the need to develop policies and implement a more concerted program to increase access to health care delivered under the medical home model for CSHCN and non-CSHCN. Policymakers, health care administrators and physician groups can use these findings to inform future policy decisions and service delivery reforms.
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9
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Wiles LK, de Wet C, Dalton C, Murphy E, Harris MF, Hibbert PD, Molloy CJ, Arnolda G, Ting HP, Braithwaite J. The quality of preventive care for pre-school aged children in Australian general practice. BMC Med 2019; 17:218. [PMID: 31805928 PMCID: PMC6896286 DOI: 10.1186/s12916-019-1455-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/28/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Variable and poor care quality are important causes of preventable patient harm. Many patients receive less than recommended care, but the extent of the problem remains largely unknown. The CareTrack Kids (CTK) research programme sought to address this evidence gap by developing a set of indicators to measure the quality of care for common paediatric conditions. In this study, we focus on one clinical area, 'preventive care' for pre-school aged children. Our objectives were two-fold: (i) develop and validate preventive care quality indicators and (ii) apply them in general medical practice to measure adherence. METHODS Clinical experts (n = 6) developed indicator questions (IQs) from clinical practice guideline (CPG) recommendations using a multi-stage modified Delphi process, which were pilot tested in general practice. The medical records of Australian children (n = 976) from general practices (n = 80) in Queensland, New South Wales and South Australia identified as having a consultation for one of 17 CTK conditions of interest were retrospectively reviewed by trained paediatric nurses. Statistical analyses were performed to estimate percentage compliance and its 95% confidence intervals. RESULTS IQs (n = 43) and eight care 'bundles' were developed and validated. Care was delivered in line with the IQs in 43.3% of eligible healthcare encounters (95% CI 30.5-56.7). The bundles of care with the highest compliance were 'immunisation' (80.1%, 95% CI 65.7-90.4), 'anthropometric measurements' (52.7%, 95% CI 35.6-69.4) and 'nutrition assessments' (38.5%, 95% CI 24.3-54.3), and lowest for 'visual assessment' (17.9%, 95% CI 8.2-31.9), 'musculoskeletal examinations' (24.4%, 95% CI 13.1-39.1) and 'cardiovascular examinations' (30.9%, 95% CI 12.3-55.5). CONCLUSIONS This study is the first known attempt to develop specific preventive care quality indicators and measure their delivery to Australian children in general practice. Our findings that preventive care is not reliably delivered to all Australian children and that there is substantial variation in adherence with the IQs provide a starting point for clinicians, researchers and policy makers when considering how the gap between recommended and actual care may be narrowed. The findings may also help inform the development of specific improvement interventions, incentives and national standards.
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Affiliation(s)
- Louise K Wiles
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Carl de Wet
- Healthcare Improvement Unit, Clinical Excellence Division, Queensland Health, Brisbane, QLD, Australia.,School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | | | - Elisabeth Murphy
- New South Wales Ministry of Health, North Sydney, Sydney, NSW, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Charlotte J Molloy
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.
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Goyal NK, Brown CM, Folger AT, Hall ES, Van Ginkel JB, Ammerman RT. Adherence to Well-Child Care and Home Visiting Enrollment Associated with Increased Emergency Department Utilization. Matern Child Health J 2019; 24:73-81. [DOI: 10.1007/s10995-019-02821-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cohen LA, Limbers CA. Mental health and parenting stress in mothers of children with diabetes treated in a patient-centred medical home. Fam Pract 2019; 36:486-492. [PMID: 30445588 DOI: 10.1093/fampra/cmy110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mothers of children with diabetes are at-risk for experiencing parenting stress and diminished mental/emotional health. To the best of our knowledge, no studies to date have examined whether there are differences in these outcomes between mothers whose diabetic child is managed in a patient-centred medical home or not. OBJECTIVE The objective of the present study was to assess whether there were differences in mental health and parenting stress among mothers whose diabetic child was managed in a patient-centred medical home or not. METHODS Two hundred fifty-three mothers of children with diabetes (mean age = 12.50 years; SD = 3.90) from the 2011-2012 National Survey of Children's Health were included in this study. Hierarchical multiple regression was conducted to determine the amount of variance that having a patient-centred medical home contributed to maternal emotional/mental health and parenting stress. RESULTS After controlling for child sex, age, race/ethnicity and family poverty level, patient-centred medical home status was associated with better mental health for mothers and less parenting stress. Effective care coordination was the only subcomponent of the patient-centred medical home that significantly contributed to the variance in mother's mental/emotional health and parenting stress. CONCLUSIONS Receiving care in a patient-centred medical home, particularly the care coordination component, may mitigate some of the negative maternal effects of managing a child's diabetes.
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Affiliation(s)
- L Adelyn Cohen
- Department of Psychology and Neuroscience, Baylor University Waco, TX, USA
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12
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Balistreri KS. Food insufficiency and children with special healthcare needs. Public Health 2019; 167:55-61. [PMID: 30639804 DOI: 10.1016/j.puhe.2018.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/17/2018] [Accepted: 11/20/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the prevalence of food insufficiency, a more severe form of food insecurity, across levels of special healthcare needs among a nationally representative sample of children in the United States. The study also investigates whether medical home access serves as a possible protective mechanism against food hardship. STUDY DESIGN The study involves analysis of nationally representative cross-sectional data. METHODS The data used are the 2016 National Survey of Children's Health, a cross-sectional nationally representative sample of the US children (N = 48,709). Descriptive analyses and logistic regression analysis are used to estimate food insufficiency and its correlates by complexity of children's special healthcare needs. RESULTS Analysis showed that children with more complex special healthcare needs experienced roughly twice the rate of food insufficiency compared with children with no special healthcare needs or children with less complex healthcare needs. Multivariate analysis indicated that children with more complex healthcare needs face an increased risk of food insufficiency net of demographic and economic characteristics. Interaction models revealed that medical home access protects children with medical complexity from food insufficiency. CONCLUSIONS These findings document significantly elevated risk of food insufficiency among families with a child facing more complex special healthcare needs. Interventions in healthcare settings could include referrals to resources already in place to combat hunger such as food bank agencies and other resources that might help at-risk families obtain assistance through programs such as the Supplemental Nutrition Assistance Program and Women, Infants, and Children.
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13
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Lichstein JC, Ghandour RM, Mann MY. Access to the Medical Home Among Children With and Without Special Health Care Needs. Pediatrics 2018; 142:peds.2018-1795. [PMID: 30498076 DOI: 10.1542/peds.2018-1795] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2018] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5840358562001PEDS-VA_2018-1795Video Abstract OBJECTIVES: The medical home is central to providing quality health care for children. Access to the medical home has historically been tracked by using the National Survey of Children With Special Health Care Needs and the National Survey of Children's Health (NSCH). Between 2012 and 2015, the NSCH was redesigned, combining the 2 surveys into a single, annual assessment. In this study, we provide the latest estimates of medical home access among children in the United States. METHODS We used data from the 2016 NSCH (N = 50 212). Medical home access was defined as a composite measure composed of 5 subcomponents (usual source of care, personal doctor or nurse, referral access, receipt of care coordination, and receipt of family-centered care) for 50 177 US children aged 0 to 17 years. We conducted bivariate analyses and logistic regression to examine the sociodemographic and health characteristics associated with reported attainment of the medical home composite measure and each subcomponent. Analyses were survey weighted. RESULTS In 2016, 43.2% of children with special health care needs (CSHCN) and 50.0% of non-CSHCN were reported to have access to a medical home. Attainment of the medical home composite measure varied significantly by sociodemographic characteristics among both CSHCN and non-CSHCN, as did attainment rates for each of the 5 subcomponents. The medical complexity of CSHCN was also associated with attainment rates of all outcomes. CONCLUSIONS The medical home incorporates elements of care considered necessary for providing comprehensive, quality care. Our results indicate that there is still room to improve access to the medical home among all children.
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Affiliation(s)
- Jesse C Lichstein
- Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland
| | - Reem M Ghandour
- Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland
| | - Marie Y Mann
- Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland
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Fuentes M, Coker TR. Social Complexity as a Special Health Care Need in the Medical Home Model. Pediatrics 2018; 142:peds.2018-2594. [PMID: 30498075 DOI: 10.1542/peds.2018-2594] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Molly Fuentes
- Seattle Children's Research Institute, Seattle, Washington; and .,Departments of Rehabilitation Medicine and
| | - Tumaini R Coker
- Seattle Children's Research Institute, Seattle, Washington; and.,Pediatrics, University of Washington, Seattle, Washington
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15
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Hirai AH, Kogan MD, Kandasamy V, Reuland C, Bethell C. Prevalence and Variation of Developmental Screening and Surveillance in Early Childhood. JAMA Pediatr 2018; 172:857-866. [PMID: 29987317 PMCID: PMC6143066 DOI: 10.1001/jamapediatrics.2018.1524] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Since 2001, the American Academy of Pediatrics has recommended universal developmental screening and surveillance to promote early diagnosis and intervention and to improve the outcomes of children with developmental delays and disabilities. OBJECTIVE To examine the current prevalence and variation of developmental screening and surveillance of children by various sociodemographic, enabling, and health characteristics. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis of the Health Resources and Services Administration's 2016 National Survey of Children's Health-a nationally representative survey of US children completed between June 2016 and February 2017-examined 5668 randomly selected children 9 through 35 months of age whose parent or caregiver responded to the address-based survey by mail or via a website. All analyses were weighted to account for the probability of selection and nonresponse and to reflect population counts of all noninstitutionalized US children residing in housing units. MAIN OUTCOMES AND MEASURES Developmental screening was measured through a validated set of 3 items indicating receipt in the past year of parent-completed screening from a health care professional with age-appropriate content regarding language development and social behavior. Surveillance was determined by an item capturing verbal elicitation of developmental concerns by a health care professional. RESULTS Of the estimated 9.0 million children aged 9 through 35 months, an estimated 30.4% (95% CI, 28.0%-33.0%) were reported by their parent or guardian to have received a parent-completed developmental screening and 37.1% (95% CI, 34.4%-39.8%) were reported to have received developmental surveillance from a health care professional in the past year. Characteristics associated with screening and/or surveillance that remained significant after adjustment included primary household language, family structure, household education, income, medical home, past-year preventive visit, child health status, and special health care needs. Having health care that meets medical home criteria was significantly associated with both developmental screening (adjusted rate ratio, 1.34; 95% CI, 1.13-1.57) and surveillance (adjusted rate ratio, 1.24; 95% CI, 1.08-1.42), representing an 8 to 9 absolute percentage point increase. State-level differences spanned 40 percentage points for screening (17.2% in Mississippi and 58.8% in Oregon) and surveillance (19.1% in Mississippi and 60.8% in Oregon), with approximately 90% of variation not explained by child and family characteristics. CONCLUSIONS AND RELEVANCE Despite more than a decade of initiatives, rates of developmental screening and surveillance remain low. However, state-level variation indicates continued potential for improvement. Systems-level quality improvement efforts, building on the medical home, will be necessary to achieve recommended screening and surveillance goals.
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Affiliation(s)
- Ashley H. Hirai
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
| | - Michael D. Kogan
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
| | - Veni Kandasamy
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Colleen Reuland
- Department of Pediatrics, Oregon Health and Sciences University, Portland
| | - Christina Bethell
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Ghandour RM, Jones JR, Lebrun-Harris LA, Minnaert J, Blumberg SJ, Fields J, Bethell C, Kogan MD. The Design and Implementation of the 2016 National Survey of Children's Health. Matern Child Health J 2018; 22:1093-1102. [PMID: 29744710 PMCID: PMC6372340 DOI: 10.1007/s10995-018-2526-x] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction Since 2001, the Health Resources and Services Administration's Maternal and Child Health Bureau (HRSA MCHB) has funded and directed the National Survey of Children's Health (NSCH) and the National Survey of Children with Special Health Care Needs (NS-CSHCN), unique sources of national and state-level data on child health and health care. Between 2012 and 2015, HRSA MCHB redesigned the surveys, combining content into a single survey, and shifting from a periodic interviewer-assisted telephone survey to an annual self-administered web/paper-based survey utilizing an address-based sampling frame. Methods The U.S. Census Bureau fielded the redesigned NSCH using a random sample of addresses drawn from the Census Master Address File, supplemented with a unique administrative flag to identify households most likely to include children. Data were collected June 2016-February 2017 using a multi-mode design, encouraging web-based responses while allowing for paper mail-in responses. A parent/caregiver knowledgeable about the child's health completed an age-appropriate questionnaire. Experiments on incentives, branding, and contact strategies were conducted. Results Data were released in September 2017. The final sample size was 50,212 children; the overall weighted response rate was 40.7%. Comparison of 2016 estimates to those from previous survey iterations are not appropriate due to sampling and mode changes. Discussion The NSCH remains an invaluable data source for key measures of child health and attendant health care system, family, and community factors. The redesigned survey extended the utility of this resource while seeking a balance between previous strengths and innovations now possible.
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Affiliation(s)
- Reem M Ghandour
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD, USA.
- Division of Epidemiology, Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, 5600 Fishers Lane, Room 18N122, Rockville, MD, 20857, USA.
| | - Jessica R Jones
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD, USA
| | - Lydie A Lebrun-Harris
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD, USA
| | - Jessica Minnaert
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD, USA
| | - Stephen J Blumberg
- U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD, USA
| | - Jason Fields
- Demographic Directorate - Survey Operations, Economic and Statistics Administration, U.S. Census Bureau, Suitland, MD, USA
| | - Christina Bethell
- Child and Adolescent Health Measurement Initiative, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael D Kogan
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD, USA
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Burton RA, Lallemand NM, Peters RA, Zuckerman S. Characteristics of Patient-Centered Medical Home Initiatives that Generated Savings for Medicare: a Qualitative Multi-Case Analysis. J Gen Intern Med 2018; 33:1028-1034. [PMID: 29404947 PMCID: PMC6025664 DOI: 10.1007/s11606-018-4309-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 12/01/2017] [Accepted: 12/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Through the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, Medicare, Medicaid, and private payers offered supplemental payments to 849 primary care practices that became patient-centered medical homes (PCMHs) in eight states; practices also received technical assistance and data reports. Average Medicare payments were capped at $10 per beneficiary per month in each state. OBJECTIVE Since there was variation in the eight participating states' demonstration designs, experiences, and outcomes, we conducted a qualitative multi-case analysis to identify the key factors that differentiated states that were estimated to have generated net savings for Medicare from states that did not. PARTICIPANTS States' MAPCP Demonstration initiatives were comprehensively profiled in case studies based on secondary document review, three rounds of annual interviews with state staff, payers, practices, and other stakeholders, and other data sources. APPROACH Case study findings were summarized in a case-ordered predictor-outcome matrix, which identified the presence or absence of key demonstration design features and experiences and arrayed states based on the amount of net savings or losses they generated for Medicare. We then used this matrix to identify initiative features that were present in at least three of the four states that generated net savings and absent from at least three of the four states that did not generate savings. RESULTS A majority of the states that generated net savings: required practices to be recognized PCMHs to enter the demonstration, did not allow late entrants into the demonstration, used a consistent demonstration payment model across participating payers, and offered practices opportunities to earn performance bonuses. Practices in states that generated net savings also tended to report receiving the demonstration payments and bonuses they expected to receive, without any issues. CONCLUSIONS Designers of future PCMH initiatives may increase their likelihood of generating net savings by incorporating the demonstration features we identified.
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Guerrero AD, Zhou X, Chung PJ. How Well is the Medical Home Working for Latino and Black Children? Matern Child Health J 2017; 22:175-183. [PMID: 29127621 DOI: 10.1007/s10995-017-2389-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective To examine the benefits of having a medical home among Latino and Black school-aged children, both with and without special health care needs (CSHCN). Methods Data from the 2011-2012 National Survey of Children's Health (NSCH) were analyzed to examine the associations of preventive dental and medical care, unmet dental or medical care, or missed school days with having a medical home among Latino and Black children compared to White children. Multivariate logistic regression with survey weights was used to adjust for child, parent, home, and geographic characteristics and an interaction term to estimate differences in outcomes among Black or Latino children receiving care in a medical home compared to White children with a medical home. Results Approximately 35% of Latino CSHCN and Latino non-CSHCN ages 6-17 years of age had a medical home. In the adjusted model comparing the effectiveness of the medical home by race and ethnicity, Latino non-CSHCN compared to White non-CSHCN were associated with lower odds of having one or more preventive dental visit in the last 12 months (OR 0.66; 95% CI 0.46-0.95) and no other associations between having a medical home and outcomes were found among Latinos compared to Whites regardless of non-CSHCN or CHSCN status. Meanwhile, having a medical home among Black non-CHSCN and CHSCN, compared to their White counterparts, showed potential benefits in regards to unmet medical care needs after adjusting for covariates, (OR 0.15; 95% CI 0.06-0.35; OR 0.16; 95% CI 0.05-0.55). Conclusions Medical homes may not be effective in delivering health services to the majority of Latino children but provide some benefit to Black children with and without CSHCN. Alternatively, the medical home may function differently for Latinos due to the specific medical home components measured by NSCH.
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Affiliation(s)
- Alma D Guerrero
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
- UCLA Center for Healthier Children, Families and Communities, Los Angeles, CA, USA.
- Children's Discovery and Innovation Institute Mattel Children's Hospital UCLA, Los Angeles, CA, USA.
| | - Xinkai Zhou
- Department of Medicine, Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Paul J Chung
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Children's Discovery and Innovation Institute Mattel Children's Hospital UCLA, Los Angeles, CA, USA
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- The RAND Corporation, Santa Monica, CA, USA
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Strobel NA, Arabena K, East CE, Schultz EM, Kelaher M, Edmond KM, Eades SJ, Chamberlain C. Care co-ordination interventions to improve outcomes during pregnancy and early childhood (up to 5 years). Hippokratia 2017. [DOI: 10.1002/14651858.cd012761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Natalie A Strobel
- The University of Western Australia; School of Biomedical Sciences; 35 Stirling Highway Crawley Western Australia Australia 6009
| | - Kerry Arabena
- The University of Melbourne; Onemda VicHealth Group, Centre for Health Equity, Melbourne School of Population and Global Health; Level 4, 207 Bouverie Street Carlton, Melbourne Victoria Australia 3010
| | - Christine E East
- Monash Health; Monash Women's; 246 Clayton Road Clayton Victoria Australia 3168
| | - Ellen M Schultz
- American Institutes for Research; Research and Evaluation; 10 S. Riverside Plaza Chicago IL USA 60606
| | - Margaret Kelaher
- The University of Melbourne; Centre for Health Policy, Melbourne School of Population and Global Health; Level 4, 207 Bouverie Street Carlton, Melbourne Victoria Australia 3010
| | | | - Sandra J Eades
- Baker IDI Heart & Diabetes Institute; Aboriginal Health Domain; L4/99 Commercial Rd Prahan Melbourne Victoria Australia 3004
| | - Catherine Chamberlain
- La Trobe University; Judith Lumley Centre; 251 Faraday Street Melbourne Vic Australia 3000
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20
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deJong NA, Dellon EP, Vander Schaaf EB, Stiles AD, Carr RA, Steiner MJ. Enhanced Access and Parents' Preferred Contact for a Child's Chronic Condition. J Pediatr 2017; 180:235-240.e1. [PMID: 27742127 DOI: 10.1016/j.jpeds.2016.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/18/2016] [Accepted: 09/06/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess whether the perception of enhanced access by parents in their child's primary care and main specialty practices is associated with preference for contacting either practice when problems arise with a child's chronic condition. STUDY DESIGN In this cross-sectional survey study of parents whose children use both primary and specialty practices, we assessed perceptions of 3 components of enhanced access: (1) appointment availability when needed, (2) electronic communication with practices, and (3) other staff that help manage a child's health care needs. Parents also indicated which practice they would contact for an exacerbation of the main chronic condition for which the child receives specialty care. We used logistic regression to examine relationships of enhanced access components in both practices with parents' indicated practice. RESULTS Among 609 parents, 244 (40%) would contact primary care and 365 (60%) the main specialty practice for a chronic condition exacerbation. Although parents perceived enhanced access components with similar frequency in both settings, enhanced access was associated only with preference for contacting the main specialty practice: e-mail communication (aOR for preferring the specialty practice 2.0 [1.3, 3.2]) and staff that coordinate a child's care needs (aOR 2.8 [1.4, 5.9]). CONCLUSIONS Enhanced access is associated with preference for addressing chronic condition exacerbations in specialty but not primary care. Future study should further identify factors important to parents in deciding when and how to contact practices and should seek to develop family-centered communication within medical homes that integrate primary and specialty care.
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Affiliation(s)
- Neal A deJong
- Division of General Pediatrics and Adolescent Medicine, UNC School of Medicine, Chapel Hill, NC.
| | - Elisabeth P Dellon
- Division of Pediatric Pulmonology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Emily B Vander Schaaf
- Division of General Pediatrics and Adolescent Medicine, UNC School of Medicine, Chapel Hill, NC
| | - Alan D Stiles
- University of North Carolina Health Care System, Chapel Hill, NC
| | - Rachael A Carr
- University of North Carolina Health Care System, Chapel Hill, NC
| | - Michael J Steiner
- Division of General Pediatrics and Adolescent Medicine, UNC School of Medicine, Chapel Hill, NC
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Abstract
OBJECTIVES To examine the relationship between adverse childhood experiences (ACE), access to a medical home and a global measure of well-being among children ages 6-17 using the 2011-2012 National Survey of Children's Health. METHODS Multivariate linear regressions assessed the associations between each adverse experience and an index of child well-being with and without the impact of other events. The number of ACE was summed for each respondent and the analyses were repeated with the cumulative score as a continuous variable. The cumulative model was repeated with the addition of an interaction term between ACE score and medical home access. All analyses were conducted separately for children ages 6-11 and adolescents 12-17. RESULTS Over half (53 %) of US children ages 6-17 have experienced some adverse experience during childhood. Over a quarter (28 %) has experienced at least two adverse experiences, while 15 % have experienced three or more hardships. Results suggest that the accumulation of ACE reduces well-being in children. The associations remained significant after controlling for gender, race/ethnicity, age, parental education, special health condition, and medical home access. Medical home access was consistently associated with higher levels of child well-being and was a significant moderator of the relationship between the total ACE and child well-being among children ages 6-11. Children with ACE exposure and access to a medical home have higher levels of well-being than comparable children without access to a medical home. CONCLUSIONS FOR PRACTICE Children exposed to adverse experiences have measurably lower levels of well-being, although younger children with access to a medical home are protected at increasing exposure.
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Affiliation(s)
- Kelly Stamper Balistreri
- Center for Family and Demographic Research, Bowling Green State University, 218 Williams Hall, Bowling Green, OH, 43403, USA.
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Scribano PV. Charting the Course of Improved Health for Children in Foster Care. Curr Probl Pediatr Adolesc Health Care 2015; 45:282-5. [PMID: 26372431 DOI: 10.1016/j.cppeds.2015.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Philip V Scribano
- Department of Pediatrics, Safe Place: Center for Child Protection and Health, The Children׳s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Abstract
PURPOSE OF REVIEW Originally conceived by pediatricians as a model for the care of children with special healthcare needs, the 'patient-centered medical home' (PCMH) has been identified by the Affordable Care Act as a model for all future outpatient care delivery. Although few studies have demonstrated its efficacy in improving care for children with congenital heart disease (CHD), access to a PCMH is likely to improve CHD-patient outcomes, including global function and quality of life, while reducing healthcare costs. RECENT FINDINGS To date, most patients with complex CHD have their care anchored in cardiology subspecialty-care clinics, which lack many of the attributes of a PCMH. Given that many of these patients have noncardiac morbidities, including neurocognitive impairment and multiorgan dysfunction, we believe such patients will benefit from a PCMH model of care based on primary care. SUMMARY The PCMH based on primary care for patients with complex CHD could result in improved clinical outcomes, improved patient satisfaction and quality of life as well as decreased healthcare costs. Policy and practice reform are required to increase CHD-patient access to a PCMH, based on primary-care settings.
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Christensen AL, Zickafoose JS, Natzke B, McMorrow S, Ireys HT. Associations between practice-reported medical homeness and health care utilization among publicly insured children. Acad Pediatr 2015; 15:267-74. [PMID: 25906698 DOI: 10.1016/j.acap.2014.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 12/04/2014] [Accepted: 12/08/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND The patient-centered medical home (PCMH) is widely promoted as a model to improve the quality of primary care and lead to more efficient use of health care services. Few studies have examined the relationship between PCMH implementation at the practice level and health care utilization by children. Existing studies show mixed results. METHODS Using practice-reported PCMH assessments and Medicaid claims from child-serving practices in 3 states participating in the Children's Health Insurance Program Reauthorization Act of 2009 Quality Demonstration Grant Program, this study estimates the association between medical homeness (tertiles) and receipt of well-child care and nonurgent, preventable, or avoidable emergency department (ED) use. Multilevel logistic regression models are estimated on data from 32 practices in Illinois (IL) completing the National Committee for Quality Assurance's (NCQA) medical home self-assessment and 32 practices in North Carolina (NC) and South Carolina (SC) completing the Medical Home Index (MHI) or Medical Home Index-Revised Short Form (MHI-RSF). RESULTS Medical homeness was not associated with receipt of age-appropriate well-child visits in either sample. Associations between nonurgent, preventable, or avoidable ED visits and medical homeness varied. No association was seen among practices in NC and SC that completed the MHI/MHI-RSF. Children in practices in IL with the highest tertile NCQA self-assessment scores were less likely to have a nonurgent, preventable, or avoidable ED visit than children in practices with low (odds ratio 0.65; 95% confidence interval 0.47-0.92; P < .05) and marginally less likely to have such a visit compared with children in practices with medium tertile scores (odds ratio 0.72, 95% confidence interval 0.52-1.01; P = .06). CONCLUSIONS Higher levels of medical homeness may be associated with lower nonurgent, preventable, or avoidable ED use by publicly insured children. Robust longitudinal studies using multiple measures of medical homeness are needed to confirm this observation.
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Abstract
OBJECTIVE To determine the association between a widely used individual-level assessment of the medical home derived from parental perception and practice-level assessment of the medical home. METHODS Thirty parents at each of 6 Boston-area community health centers (CHCs) were administered the 19-question medical home measure of the 2011 National Survey of Children's Health (NSCH). Each CHC was scored in accordance with the National Committee for Quality Assurance (NCQA) 2011 Patient-Centered Medical Home Standards and Guidelines. Bivariate analysis of the independent variables against the dependent variable (the NCQA measure, assessed as both a continuous score and a categorical tier) was performed. Linear and logistical regression models accounting for the cluster design were then constructed, with the NSCH measure as the primary predictor. RESULTS Of the 180 parents, 52% had a medical home according to the NSCH criteria. Of the 6 CHCs, 5 were a medical home according to the NCQA Standards (2 at Tier 3, 3 at Tier 2). Regression modeling demonstrated nonsignificant associations between both the continuous and categorical (tier) NCQA scores and the NSCH assessment of the medical home, with a β of -2.80 (95% confidence interval, -7.75 to 13.35) and an adjusted odds ratio of 2.17 (95% confidence interval, 0.82 to 5.74), respectively. CONCLUSIONS There was no significant association between the individual-level and practice-level assessments of the medical home. Given this discrepancy, our results suggest that we may need to temper our expectations that the medical home transformation currently being implemented at the practice level will lead to the child health and health care utilization outcomes extensively demonstrated in the literature.
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Affiliation(s)
- Webb E Long
- Division of General Pediatrics, Department of Pediatrics, University of Massachusetts Medical School/UMass Memorial Children's Medical Center, Worcester, Massachusetts; and
| | - Arvin Garg
- Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
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Brown CM, Perkins J, Blust A, Kahn RS. A Neighborhood-Based Approach to Population Health in the Pediatric Medical Home. J Community Health 2014; 40:1-11. [DOI: 10.1007/s10900-014-9885-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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