The value of the medical home for children without special health care needs
Long, Webb E.
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Objective: Although the medical home is promoted for all children by the AAP and the Affordable Care Act, its impact on the majority of the pediatric population - children without special health care needs- is unknown. We examined whether the medical home is associated with beneficial health care utilization and health promoting behaviors in this population, and whether the effect of the medical home is influenced by cumulative social risk. Methods: This was a secondary data analysis of the 2003 National Survey of Children's Health (NSCH). Data were available for 102,353 children, 82% of whom did not have special health care needs. We operationalized the medical home per the NSCH design. Logistic regression for complex sample surveys was used to model each outcome with the medical home, controlling for sociodemographics. Results: Overall, a slight minority of children had a medical home, including 46.6% of those without special health care needs. Among those children, the medical home was significantly associated with decreased emergency department (aOR 0.73, 95% Cl 0.67- 0.79) and PCP sick-visits (aOR 0.85, 95% Cl 0.79-0.91), and with increased preventive care visits (aOR 1.59, 95% Cl 1.48-1.72). It was also associated with anticipatory guidance outcomes such as being read to (aOR 1.28, 95% Cl 1.03-1.58), helmet use (aOR 1.27, 95% Cl1.12-1.44), and decreased screen time (aOR 1.12, 95% Cl1.03- 1.21 ). There was no consistent trend in association between the medical home and the various outcomes across social risk strata. Conclusions: For children without special health care needs, the medical home is associated with beneficial health and anticipatory guidance outcomes. These findings support the AAP and Affordable Care Act recommendations to extend the medical home to all children.
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