The patient-centered medical home, practice patterns, and functional outcomes for children with attention deficit/hyperactivity disorder

Acad Pediatr. Nov-Dec 2011;11(6):500-7. doi: 10.1016/j.acap.2011.08.010. Epub 2011 Oct 2.

Abstract

Objective: To determine whether children with attention deficit/hyperactivity disorder (ADHD) receive care in a patient-centered medical home (PCMH) and how that relates to their ADHD treatment and functional outcomes.

Methods: Cross-sectional analysis of the 2007 National Survey for Children's Health, a nationally representative survey of 91,642 parents. This analysis covers 5169 children with parent-reported ADHD ages 6-17. The independent variable is receiving care in a PCMH. Main outcome measures are receiving ADHD medication, mental health specialist involvement, and functional outcomes (difficulties with participation in activities, attending school, making friends; having problem behaviors; missed school days; and number of times parents contacted by school).

Results: Only 44% of children with ADHD received care in a PCMH. Children with ADHD receiving care in a PCMH compared with those who did not were more likely to receive medication for ADHD (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1-1.9); less likely to have mental health specialist involvement (OR, 0.6; 95% CI, 0.4-0.7); less likely to have difficulties participating in activities (OR, 0.6; 95% CI 0.4-0.8), making friends (OR, 0.6; 95% CI, 0.5-0.9), and attending school (OR, 0.4; 95% CI, 0.3-06); less likely to have problem behaviors (OR 0.6; 95% CI 0.5-0.9); had fewer missed school days (β = -1.5, 95% CI -2.4 to -0.5); and parents were contacted by school less frequently (β = -0.2, 95% CI -0.3 to -0.1).

Conclusions: For children with ADHD, receiving care in a PCMH is associated with practice pattern change and better outcomes. The PCMH may represent a promising opportunity to improve quality of care and outcomes for children with ADHD.

MeSH terms

  • Adolescent
  • Attention Deficit Disorder with Hyperactivity / epidemiology
  • Attention Deficit Disorder with Hyperactivity / psychology*
  • Attention Deficit Disorder with Hyperactivity / therapy*
  • Child
  • Cross-Sectional Studies
  • Female
  • Humans
  • Logistic Models
  • Male
  • Patient-Centered Care* / methods
  • Patient-Centered Care* / statistics & numerical data
  • Practice Patterns, Physicians'
  • Quality of Life*
  • Severity of Illness Index
  • Treatment Outcome
  • United States / epidemiology