Strengthening the Medical Home for Children Child Health Policy Research Symposium 2009

Session Purpose Examine the concept of a medical home and review some national data on its quality. Perspectives—clinical and policy—on what can be done to support medical home efforts. Group discussion on promoting medical home concepts locally and at policy levels.

What is a Medical Home? A medical home is not a person, building or hospital, but rather an approach to providing comprehensive primary care. The care should be: accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective. Source: American Academy of Pediatrics, 2004

Not Limited to Special Needs A medical home is not limited in any way to children with special needs. All children are likely to benefit from this approach to care. Initially for special needs children because they have the most complex needs and thus the most to gain or lose from the system.

Data Sources for Medical Home The National Survey of Children with Special Health Care Needs provides some of earliest and ongoing measurement for CSHCN. The National Survey of Children’s Health also provides medical home data but for children regardless of special needs.

General Findings Using a variety of definitions of “good quality” medical home, studies show that roughly half of CSHCN have a quality medical home. Most studies demonstrate significant variation in quality based on common risk factors such as lacking insurance, poverty status, race, etc.

National Data on Medical Home Source: Stevens GD, Seid M, Pickering T, Tsai K. National disparities in the quality of a medical home for children. Mat Child Health J. In press, 2009.

National Data on Medical Home Source: Stevens GD, Seid M, Pickering T, Tsai K. National disparities in the quality of a medical home for children. Mat Child Health J. In press, 2009.

Implications Studies have shown that CSHCN with a good quality medical home are less likely to have an emergency department visit, lower costs, etc. Our analysis among children with asthma: – 18% lower odds of any reported parent burden – 21% lower odds of emergency visit (non-AIP) Source: Stevens GD, Pickering TR, Seid M, Tsai K. National disparities in the quality of a medical home for children with asthma. Academic Pediatrics. In press.

How Do We Promote a Medical Home for Children?