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Rast JE, Roux AM, Connor G, Ezeh TH, Shea L, Turchi RM, Shattuck PT. The Medical Home and Mental Health Services in Children and Youth with Special Health Care Needs. Matern Child Health J 2023; 27:1097-1106. [PMID: 36988794 DOI: 10.1007/s10995-023-03652-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND AND OBJECTIVES Children and youth with special health care needs (CYSHCN) commonly experience mental health concerns, but conditions are often not identified or treated within primary care. Mental health care is often not a primary focus of pediatric primary care, but the medical home model has potential to address these concerns more adequately. The purpose of this study is to examine the relationship between the medical home and use of mental health services in CYSHCN. METHODS Data came from the Medical Expenditure Panel Survey years 2015-2017, a nationally representative survey of health and healthcare in US families. The study included CYSHCN ages 6-17. We compared the use of mental health services, expenditures, and psychotropic medications across CYSHCN with and without a medical home using multivariable regression. RESULTS 45% of CYSHCN received care within a medical home. CYSHCN with and without a medical home reported similar frequency of office-based mental health visits (21.2% versus 25.2%), average expenditures for visits ($147 versus $128), and psychotropic medications (11.9% versus 15.1%). Medical home status was not associated with office-based mental health visits, use of psychotropic medications, or cost for either. CONCLUSIONS CYSHCN with mental health care needs face barriers to satisfactory care. Creating better connections between primary and mental health care could help to ameliorate this problem. Findings suggest the medical home, a more comprehensive primary care model, may not address mental health care needs of CYSHCN.
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Affiliation(s)
- Jessica E Rast
- A.J. Drexel Autism Institute, Drexel University, 3020 Market St. Suite 560, Philadelphia, PA, 19104, USA.
| | - Anne M Roux
- A.J. Drexel Autism Institute, Drexel University, 3020 Market St. Suite 560, Philadelphia, PA, 19104, USA
| | - Gabrielle Connor
- A.J. Drexel Autism Institute, Drexel University, 3020 Market St. Suite 560, Philadelphia, PA, 19104, USA
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Tobechukwu H Ezeh
- A.J. Drexel Autism Institute, Drexel University, 3020 Market St. Suite 560, Philadelphia, PA, 19104, USA
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Lindsay Shea
- A.J. Drexel Autism Institute, Drexel University, 3020 Market St. Suite 560, Philadelphia, PA, 19104, USA
| | - Renee M Turchi
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- St. Christopher's Hospital for Children, Philadelphia, PA, USA
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Sojar S, Gjelsvik A, Tsao HS, Amanullah S. Do Unmet Health Needs Drive Pediatric Emergency Department Utilization?: A Population-Based Assessment. Pediatr Emerg Care 2022; 38:e569-e574. [PMID: 33635045 DOI: 10.1097/pec.0000000000002319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Lack of access to basic health services is thought to increase emergency department (ED) utilization. This study assessed the relationship between unmet health care needs and pediatric ED utilization in the United States. METHODS The National Survey of Children's Health was used (2016-2017; n = 71,360). Parent/guardians reported number of ED visits and the presence of unmet health needs (medical, dental, mental health, vision, hearing, other) in the last 12 months. Associations were analyzed using multinomial logistic regression modeling and accounted for the weighting and complex survey design of the National Survey of Children's Health. RESULTS Children with 2 or more unmet health needs had 3.72 times (95% confidence interval, 2.25-6.16) risk of ≥2 ED visits when compared with those with 0 unmet health needs. This risk became nonsignificant when adjusted for race, ethnicity, age, insurance, having asthma, current medication status, health description, number of preventative health visits, and place to go for preventative health (aRR, 1.77; 95% confidence interval, 0.96-3.27). The adjusted association was also nonsignificant for specific types of unmet needs. Race, insurance status, age 0 to 3 years, current medication status, having asthma, ≥2 preventative visits, and poorer health were associated with ≥2 ED visits. CONCLUSIONS Unmet health needs were not found to be a significant driving force for ED utilization. Other factors were found to be more strongly associated with it. Future studies to understand the perception, motives, and complex interaction of various factors leading to ED use in high-risk populations may optimize care for these children.
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Health Service and Functional Measures of Benefit of a Medical Home in Children with Autism. Matern Child Health J 2021; 25:1156-1163. [PMID: 33914226 DOI: 10.1007/s10995-021-03150-2] [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: 04/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES A medical home is a model of patient-centered, comprehensive care recommended by the American Academy of Pediatrics for all children. The aims of this study were (1) to determine if the presence of a medical home is associated with improved health service outcomes of children with autism, and (2) to determine if the presence of a medical home is associated with improved key functional outcomes in children with autism. METHODS This study used data from the 2016-2017 National Survey of Children's Health. We used a medical home construct of 14 survey questions as the main independent variable in logistic regression models estimating cross-sectional association, and also evaluated the interaction between medical home and demographic and household characteristics, including race, income, household composition, and autism severity in regression for outcomes. RESULTS Overall, the presence of a medical home was associated with increased parent reporting of shared health care decision-making, receipt of preventive pediatric care, and reduced frustration in accessing services. Some functional outcomes were also positively associated with the presences of a medical home in children with parent-reported mild autism symptoms; children who had a medical home visited the ED less often than children without a medical home. This did not persist for children with moderate or severe parent-rated autism. CONCLUSIONS FOR PRACTICE: Based on parent-reported, cross-sectional data from a large, nationally representative sample of families with a child with autism, the presence of a medical home was positively associated with some improved health services and functional outcomes.
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Perez Jolles M, Zullig LL, Lee PJ, Kolhatkar G. Disparities in Shared Decision Making and Service Receipt Among Children With Special Health Care Needs and Developmental Delay: A National Survey Analysis. J Prim Care Community Health 2020; 11:2150132720924588. [PMID: 32560592 PMCID: PMC7307398 DOI: 10.1177/2150132720924588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Shared decision making (SDM) is associated with increased service satisfaction among pediatric patients. Our objective was to examine the association between SDM and service use experiences across racial/ethnic child groups. This secondary data analysis used the 2009-2010 National Survey of Children with Special Health Care Needs (CSHCN) and 2011 Pathways to Diagnosis and Services Survey. We used a rank-and-replace matching approach consistent with Institute of Medicine recommendations for health disparities research. We included CSHCN aged 6 to 17 years. The exposure of interest was parents of CSHCN reporting engagement in SDM with clinicians. There were 4032 CSHCN included in analysis. CSHCNs experiencing SDM had a 16% higher probability of reporting service use compared to those not experiencing it (95% CI, 14.24-19.42). Black children experiencing SDM reported seeing all needed care providers at a lower rate than whites (79% and 87.6% respectively; 95% CI, -14.05-3.27). The benefit of SDM over not experiencing it for blacks was 12.2% less than for whites for the outcome of seeing all needed care providers. For the outcome of receiving all needed treatments and services, the SDM benefit was 9.1% lower for Hispanics compared with whites. SDM can improve service experiences but implementation flexibility may be needed.
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Affiliation(s)
| | - Leah L Zullig
- Durham Veterans Affairs Health Care System, Duke University Medical Center, Durham, NC, USA
| | - Pey-Jiuan Lee
- University of Southern California, Los Angeles, CA, USA
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Association between Practice Participation in a Pediatric-focused Medical Home Learning Collaborative and Reduction of Preventable Emergency Department Visits by Publicly-insured Children in Massachusetts. Pediatr Qual Saf 2018; 3:e097. [PMID: 30584624 PMCID: PMC6221592 DOI: 10.1097/pq9.0000000000000097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 07/10/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction: This study evaluates the impact of practice participation in a pediatric patient-centered medical home learning collaborative on preventable emergency department (ED) visits among children in MassHealth (Massachusetts Medicaid/Children’s Health Insurance Program). Methods: Claims and enrollment data were extracted for child MassHealth members (aged 3–18) comprising 2 groups: members enrolled in a group of 13 child-serving practices that participated in an intensive, 29-month long patient-centered medical home learning collaborative (intervention group), and members enrolled in a group of 12 comparison practices with roughly similar panel size, type, and geographic location (comparison group). Preventable ED visits were identified using a modified version of the New York University ED algorithm. Two analyses were then conducted: (1) a repeat cross-sectional analysis among children enrolled in intervention or comparison group practices during baseline (first half of 2011) and follow-up (second half of 2013) periods; and (2) a longitudinal analysis among a subset of children enrolled for the full study period (2011–2013). Both analyses tested whether the effect of the intervention differed for children with versus without chronic conditions (effect modification). Results: Preventable ED visits declined from baseline to follow-up among children in both intervention and comparison practices. In the cross-sectional analysis, the decrease was the same in both practice groups, and for children with versus without chronic conditions. The longitudinal analysis shows a statistically significantly greater decrease among children with chronic conditions enrolled in the intervention practices (P = 0.02). Conclusion: Children with chronic conditions might receive the greatest benefit from receiving care in a medical home setting.
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Hu X, Phillips VL, Gaydos LM, Joski P. Association of Healthy Home Environments and Use of Patient-Centered Medical Homes by Children of Low-Income Families. J Pediatr Health Care 2017; 31:203-214. [PMID: 27692504 DOI: 10.1016/j.pedhc.2016.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/28/2016] [Accepted: 08/12/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Medicaid agencies have been promoting the patient-centered medical home (PCMH) model. Most caregivers choose physician practices for their children, and we hypothesized that those following healthier childrearing practices are more likely to seek care in a PCMH. METHOD We selected children with public insurance plans (n = 20,801) from the 2011-2012 National Survey of Children's Health. We used generalized ordinal logistic regression with state fixed effects to assess the association between home environments and children's use of PCMHs. RESULTS Children living in the healthiest homes were 1.33 times (p = .001) more likely to receive care from the highest level of PCMH. In states with early PCMH implementation, the odds increased to 2.11 times (p = .001). DISCUSSION Our results show a significant, sizeable relationship between healthier home environments and the use of PCMH by children from low-income families. They provide implications for assessing the effect of PCMH use on health outcomes and use patterns.
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Raphael JL, Cooley WC, Vega A, Kowalkowski MA, Tran X, Treadwell J, Giardino AP, Giordano TP. Outcomes for Children with Chronic Conditions Associated with Parent- and Provider-reported Measures of the Medical Home. J Health Care Poor Underserved 2016; 26:358-76. [PMID: 25913335 DOI: 10.1353/hpu.2015.0051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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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Meehan E, Reid SM, Williams K, Freed GL, Babl FE, Sewell JR, Rawicki B, Reddihough DS. Tertiary paediatric emergency department use in children and young people with cerebral palsy. J Paediatr Child Health 2015; 51:994-1000. [PMID: 25976361 DOI: 10.1111/jpc.12919] [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] [Accepted: 04/07/2015] [Indexed: 11/28/2022]
Abstract
AIMS The aim of this study was to describe the pattern of tertiary paediatric emergency department (ED) use in children and young people with cerebral palsy (CP). METHODS A retrospective analysis of ED data routinely collected at the two tertiary paediatric hospitals in Victoria, Australia, cross-matched with the Victorian Cerebral Palsy Register. Data pertaining to the ED presentations of 2183 registered individuals born 1993-2008 were obtained. RESULTS Between 2008 and 2012, 37% (n = 814) of the CP cohort had 3631 tertiary paediatric ED presentations. Overall, 40% (n = 332) of presenters were residing in inner metropolitan Melbourne; 44% (n = 356) in outer Melbourne; and 13% (n = 108) in regional Victoria. Presenters were more likely than non-presenters to be younger, non-ambulant and have epilepsy. In total, 71% of presentations were triaged as Australasian Triage Scale 1-3 (urgent), and 44% resulted in a hospital admission. Disorders of the respiratory, neurological and gastrointestinal systems, and medical device problems were responsible for 72% of presentations. CONCLUSION Many of the tertiary paediatric ED presentations in this group were appropriate based on the high admission rate and the large proportion triaged as urgent. However, there is evidence that some families are bypassing local services and travelling long distances to attend the tertiary paediatric ED, even for less urgent complaints that do not require hospital admission. Alternative pathways of care delivery, and strategies to promote the management of common problems experienced by children and young people with CP in non-paediatric EDs or primary care settings, may go some way towards reducing unnecessary tertiary paediatric ED use in this group.
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Affiliation(s)
- Elaine Meehan
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Susan M Reid
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Katrina Williams
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Developmental Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Gary L Freed
- Health Systems and Workforce Unit, Centre for Health Policy, School of Global and Population Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Franz E Babl
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jillian R Sewell
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Policy, Equity and Translation Research, Population Health, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Centre for Community Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Barry Rawicki
- Paediatric Rehabilitation, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Dinah S Reddihough
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Developmental Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
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Assessing patient experiences in the pediatric patient-centered medical home: a comparison of two instruments. Matern Child Health J 2014; 18:2124-33. [PMID: 24585412 DOI: 10.1007/s10995-014-1460-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Patient-Centered Medical Home (PCMH) is a model of care that has been promoted as a way to transform a broken primary care system in the US. However, in order to convince more practices to make the transformation and to properly reimburse practices who are PCMHs, valid and reliable data are needed. Data that capture patient experiences in a PCMH is valuable, but which instrument should be used remains unclear. Our study aims to compare the validity and reliability of two national PCMH instruments. Telephone surveys were conducted with children who receive care from 20 pediatric practices across Florida (n = 990). All of the children are eligible for Medicaid or the Children's Health Insurance Program. Analyses were conducted to compare the Consumer Assessment of Health Plan Survey-Patient-Centered Medical Home (CAHPS-PCMH) and the National Survey of Children with Special Health Care Needs (NS-CSHCN) medical home domain. Respondents were mainly White non-Hispanic, female, under 35 years old, and from a two-parent household. The NS-CSHCN outperformed the CAHPS-PCMH in regard to scale reliability (Cronbach's alpha coefficients all ≥0.81 vs. 0.56-0.85, respectively). In regard to item-domain convergence and discriminant validity the CAHPS-PCMH fared better than the NS-CSHCN (range of convergence 0.66-0.93 vs. 0.32-1.00). The CAHPS-PCMH did not correspond to the scale structure in construct validity testing. Neither instrument performed well in the known-groups validity tests. No clear best instrument was determined. Further revision and calibration may be needed to accurately assess patient experiences in the PCMH.
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