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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. [ABSTRACT FROM AUTHOR]

Objectives. To assess primary care pediatric providers’ comfort with co-managing patients with rare conditions. Methods. A survey was sent via an electronic link to pediatricians and family practitioners. Chi-square test of significance and Fisher’s exact test were used for categorical variable comparisons and the Student’s t test was used for continuous variable comparisons. Results. Most of the providers believed that care decisions are most frequently made by the specialist with consultation with the primary care clinician. The most common source of information is direct communication from the specialist. The most effective tool to increase clarity and comfort about provider roles was an active care plan identifying current care needs, who will act on the plan, and when the action should be completed. Conclusions. Coordinated co-management in which caregiving roles are explicitly defined and tools are available for the timely exchange of information among all key participants warrants further study. [ABSTRACT FROM PUBLISHER]

The article discusses research which aims to characterize essential factors to the medical home transformation of pediatric primary care practices 6 to 7 years after their participation in a medical home learning collaborative in the U.S. It reveals the emergence of 4 essential medical home attributes, namely, quality improvement, care coordination, family-centered care, and team-based care. It shows that collaborative participation stimulated medical home changes in 12 pediatric practices.

OBJECTIVE: The medical home model with its emphasis on planned care, care coordination, family-centered approaches, and quality provides an attractive concept construct for primary care redesign. Studies of medical home components have shown increased quality and reduced costs, but the medical home model as a whole has not been studied systematically. This study tested the hypothesis that increased medical homeness in primary care practice is associated with decreased utilization of health services and increased patient satisfaction. METHODS: Forty-three primary care practices were identified through 7 health plans in 5 states. Using the Medical Home Index (MHI), each practice's implementation of medical home concepts "medical homeness" was measured. Health plans provided the previous year's utilization data for children with 6 chronic conditions. The plans identified 42 children in each practice with these chronic conditions and surveyed their families regarding satisfaction with care and burden of illness. RESULTS: Higher MHI scores and higher subdomain scores for organizational capacity, care coordination, and chronic-condition management were associated with significantly fewer hospitalizations. Higher chronic-condition management scores were associated with lower emergency department use. Family survey data yielded no recognizable trends with respect to the medical home measurement. CONCLUSIONS: Developing an evidence base for the value of the primary care medical home has importance for providers, payers, policy makers, and consumers. Reducing hospitalizations through enhanced primary care provides a potential case for new reimbursement strategies supporting medical home services such as care coordination. Larger-scale studies are needed to further develop/examine these relationships. [ABSTRACT FROM AUTHOR]

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 ot 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 tor household income. RESULTS: Approximately 9% of CSHCN reported having unmet specialty care needs. Care coordination was associated with reduced odds ot 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 ot 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. [ABSTRACT FROM AUTHOR]