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Medical Home for Children and Adolescents

How many children and adolescents receive care from a personal doctor or nurse that meets the definition of a medical home?

In 2003, less than one-half (46%) of U.S. children and adolescents received care that met the American Academy of Pediatrics' definition of a medical home. Rates ranged from 34 percent to 61 percent among the states.

Slide For Medical Home for Children and Adolescents
Slide For Medical Home for Children and Adolescents
Slide For Medical Home for Children and Adolescents


Why is this important?

The American Academy of Pediatrics recommends that all children and adolescents have a primary care professional (or a multidisciplinary team for children with severe chronic illnesses) whose practice serves as a medical home to help ensure that needed services are accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally effective (AAP 2002b, 2002a).

Research suggests that children who have continuity with a regular practitioner are more likely to adhere to prescribed medications, receive preventive care and well-coordinated, resource-efficient, and family-centered care, and less likely to visit the emergency department and be hospitalized; in addition, their practitioner is more likely to recognize their problems and track their information (Christakis et al. 2000; 2001; 2002; 2003; Starfield 1998; Starfield and Shi 2004).

A medical home may be especially important to children and youth with special health care needs and their families, who often need help to access and integrate services from a complex web of providers and programs (Krauss et al. 2001; Ziring et al. 1999).

Findings

In 2003, less than one-half (46%) of U.S. children and adolescents (ages 0 to 17)—and 44 percent of those with special needs—received care that was consistent with the American Academy of Pediatrics definition of a medical home.

  • Among the components of a medical home, rates ranged from 58 percent whose clinician followed up after specialty care to 92 percent whose clinician was consistently available when phone advice or urgent care was needed.
  • Compared with other children and adolescents, those with special needs were more likely to have a personal doctor or nurse, and that clinician was more likely to communicate well but was slightly less likely to be available when needed; they were less likely to receive needed specialty care without problems and follow-up by their personal clinician.
  • Younger children (56%) and those with private insurance (53%) were more likely to have a medical home than older children (40% to 43%) and those with public coverage (39%) or no insurance (23%).
  • Among the states, rates ranged from 34 percent in Mississippi to 61 percent in New Hampshire (CAHMI 2005).

Implications

The majority of children and adolescents do not receive care that meets all of the elements of a medical home as defined by pediatric experts. Barriers that must be overcome include lack of adequate reimbursement for coordination services, lack of available community services, and fragmentation among different programs, health plans, and providers serving children (Regalado and Halfon 2002).

Improvement Ideas and Resources

Tools and resources to train and support physician practices in developing a medical home for pediatric patients are available from the Center for Medical Home Improvement (CMHI 2003), the Institute for Community Inclusion (Silva et al. 2000), and the National Center of Medical Home Initiatives for Children with Special Needs (NCMHI 2003).

On behalf of the federal Maternal and Child Bureau, the National Initiative for Children's Healthcare Quality facilitated two learning collaborations to help state agencies work with primary care practices to implement and spread the medical home concept for children and youth with special health care needs. The collaborations were associated with improvements such as a reduction in unplanned hospitalizations (NICHQ 2006).

Measure:

The medical home measure is constructed according to an algorithm based on the recommendations of a technical advisory group convened by the federal Maternal and Child Health Bureau and the American Academy of Pediatrics (personal communication with Debra Read, Child and Adolescent Health Measurement Initiative, 2006):

  1. The child must have one or more health professionals considered to be a personal doctor or nurse, defined as a general doctor, pediatrician, specialist doctor, nurse practitioner, or physician's assistant who knows the child well and is familiar with the child's health history.
  2. The child also must have had at least one preventive medical care visit with any provider during the past 12 months.
  3. The child also must have a score of 75 points or more on every component of a medical home in which they needed care in order to qualify as having a medical home (a score of 75 points is the equivalent to consistently getting needed care within a specific component of medical home).
Note: more information can be obtained by e-mail from cahmi@ohsu.edu.

Children and youth with special health care needs were defined as those who have "a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally."

Limitations:

Particular components of a medical home have been shown to be beneficial to health and evidence is emerging about the benefits of the medical home concept on satisfaction and service use. Large-scale, population-based research is needed to document the health benefits associated with meeting all of the components of a medical home (as defined by this measure) to more firmly establish the policy importance of this concept (Cooley 2004).

Source:

This measure was calculated by the Child and Adolescent Health Measurement Initiative using data from the 2003 National Survey of Children's Health, a nationally representative, random-digit-dialing telephone survey of households with one or more children under 18 years old. Survey respondents are parents or guardians who know the most about a randomly selected child's health and health care (CAHMI 2005).

References:

* Indicates source of data used in the chart(s).

AAP (American Academy of Pediatrics). 2002a. Health Supervision for Children with Sickle Cell Disease. Pediatrics 109(3): 526–35.

AAP (American Academy of Pediatrics). 2002b. The Medical Home. Pediatrics 110(1 Pt 1): 184–6.

* CAHMI (Child and Adolescent Health Measurement Initiative). 2005. National Survey of Children's Health, 2003. Data Resource Center for Child and Adolescent Health. Portland: Oregon Health & Science University.

Christakis, D. A., L. Mell, T. D. Koepsell et al. 2001. Association of Lower Continuity of Care with Greater Risk of Emergency Department Use and Hospitalization in Children. Pediatrics 107 (3): 524–9.

Christakis, D. A., L. Mell, J. A. Wright et al. 2000. The Association between Greater Continuity of Care and Timely Measles-Mumps-Rubella Vaccination. American Journal of Public Health 90 (6): 962–5.

Christakis, D. A., J. A. Wright, F. J. Zimmerman et al. 2002. Continuity of Care Is Associated with High-Quality Care by Parental Report. Pediatrics 109 (4): e54.

Christakis, D. A., J. A. Wright, F. J. Zimmerman et al. 2003. Continuity of Care Is Associated with Well-Coordinated Care. Ambulatory Pediatrics 3 (2): 82–6.

CMHI (Center for Medical Home Improvement). 2003. Medical Home Improvement Kit. Lebanon, N.H.: Children's Hospital at Dartmouth-Hitchcock Medical Center, Hood Center for Children and Families.

Cooley, W. C. 2004. Redefining Primary Pediatric Care for Children with Special Health Care Needs: The Primary Care Medical Home. Current Opinion in Pediatrics 16 (6): 689–92.

Krauss, M., N. Wells, S. Gulley et al. 2001. Navigating Systems of Care: Results from a National Survey of Families of Children with Special Health Care Needs. 4 (4): 165–187.

NCMHI (National Center of Medical Home Initiatives for Children with Special Needs). 2003. Every Child Deserves a Medical Home: Training Program. Elk Grove, Ill.: American Academy of Pediatrics.

NICHQ (National Initiative for Children's Healthcare Quality). 2006. Spread of the Medical Home Concept: Comprehensive Final Report. Cambridge, Mass.: National Initiative for Children's Healthcare Quality.

Regalado, M., and N. Halfon. 2002. Primary Care Services: Promoting Optimal Child Development from Birth to Three Years. New York: The Commonwealth Fund.

Silva, T. J., L. A. Sofis, and J. S. Palfrey. 2000. Practicing Comprehensive Care: A Physician's Operations Manual for Implementing a Medical Home for Children with Special Health Care Needs. Boston, Mass.: Institute for Community Inclusion.

Starfield, B. 1998. Primary Care: Balancing Health Needs, Services, and Technology. New York, N.Y.: Oxford University Press.

Starfield, B., and L. Shi. 2004. The Medical Home, Access to Care, and Insurance: A Review of Evidence. Pediatrics 113 (5 Suppl): 1493–8.

Ziring, P. R., D. Brazdziunas, W. C. Cooley et al. 1999. American Academy of Pediatrics. Committee on Children with Disabilities. Care Coordination: Integrating Health and Related Systems of Care for Children with Special Health Care Needs. Pediatrics 104 (4 Pt 1): 978–81.