1. 1 Medical Home for Children in Washington State Washington State Data from the 2003 National Survey of Children’s Health Teresa Vollan MCH Assessment Washington State Department of Health November 2, 2006

2. 2 Purpose of Medical Home Data Project Examine who has medical home in WA, using Washington State data from National Survey of Children’s Health, 2003 Provide information to the Medical Home Strategic Planning Group and Interagency Medical Home Strike team Create short stand-alone document on Medical Home for children (Medical Home Monograph)

3. 3 Definition of Medical Home “A medical home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. A medical home is defined as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.” American Academy of Pediatrics

4. 4 National Survey of Children’s Health (NSCH) National random-digit telephone survey Administered in 2003-2004, in English and Spanish One child (age 0-17) in each household randomly selected to be the subject of interview Questions on the physical and emotional health of child and parent

5. 5 National Survey of Children’s Health (NSCH) US had 102,353 interviews WA had 1,932 interviews Data weighted to represent US and state population Paid for by MCHB, administered by NCHS 2005 data from NS-CSHCN available next year.

6. 6 Medical Home Measure in NSCH 1 To have a medical home, child must meet 6 criteria: 1.Personal doctor or nurse. Answer must be YES. 2.Received preventive medical care in past 12 months. Answer must be YES. 3.Family-centered care. Out of three questions answer must average usually/always. 1 Measure developed by the Child and Adolescent Health Measurement Initiative (CAHMI).

7. 7 Definition of Medical Home in NSCH 4.Consistently can get needed care and advice from personal doctor/nurse. Between two questions, answer must average usually/always. 5.Consistently able to access specialist care or services/equipment as needed. Must report NO problem. 6.Personal doctor/nurse follows up with family after child gets specialist care, services and/or equipment. Between two questions, answer must average usually/always.

8. 8 What percentage of children have a Medical Home? (2003 NSCH) Washington State: All Children: 48.5% (45.9, 51.1) CSHCN: 44.8% (38.5, 51.4) US: All Children: 46.1% (45.6, 46.7) CSHCN: 44.2% (42.9, 45.4)

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11. 11 Differences in Medical Home by demographics Crude analysis: Poverty status Age of child Language spoken at home Health insurance Multivariate analysis: Age and insurance were significant

12. 12 Components of the Medical Home measure

13. 13 Summary When examining the populations who have a medical home, a few demographic differences stand out: health insurance, poverty, age of child, and language. The 6 components of medical home range from 55-90% for all children. CSHCN rates were significantly higher in 2 components: having a personal Dr or nurse and preventive care CSHCN significantly lower in 1 component: easy access to specialty care and services/equipment.

14. 14 Limitations AAP definition of medical home is difficult to measure – the medical home variable used in this analysis may not be perfect. Medical home measure has changed between surveys – cannot measure over time. Survey excludes institutionalized children and families without telephone. Information is reported by parents: recall and bias (cultural differences) Small numbers in some of the analyses.

15. 15 Many thanks to Stacey De Fries and Riley Peters in the development of this presentation. My contact information: Teresa Vollan, MPH (360) 236-3566 teresa.vollan@doh.wa.gov

16. 16 Questionsfor you How will you use this information? What other information do you need? Would you like to review the Medical Home monograph?