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. 2012 Jan;129(1):87-98.
doi: 10.1542/peds.2011-1739. Epub 2011 Dec 19.

The value of the medical home for children without special health care needs

Webb E Long  1 , Howard Bauchner, Robert D Sege, Howard J Cabral, Arvin Garg
Affiliations

The value of the medical home for children without special health care needs

Webb E Long et al. Pediatrics. 2012 Jan.

Abstract

Objective: Although the medical home is promoted by the American Academy of Pediatrics and the Affordable Care Act, its impact on 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.

Methods: This study was a secondary data analysis of the 2003 National Survey of Children's Health. Data were available for 70 007 children without special health care needs. We operationalized the medical home according to the National Survey of Children's Health design. Logistic regression for complex sample surveys was used to model each outcome with the medical home, controlling for sociodemographic characteristics.

Results: Overall, 58.1% of children without special health care needs had a medical home. The medical home was significantly associated with increased preventive care visits (adjusted odds ratio [aOR]: 1.32 [95% confidence interval (CI): 1.22-1.43]), decreased outpatient sick visits (aOR: 0.71 [95% CI: 0.66-0.76), and decreased emergency department sick visits (aOR: 0.70 [95% CI: 0.65-0.76]). It was associated with increased odds of "excellent/very good" child health according to parental assessment (aOR: 1.29 [95% CI: 1.15-1.45) and health-promoting behaviors such as being read to daily (aOR: 1.46 [95% CI: 1.13-1.89]), reported helmet use (aOR: 1.18 [95% CI: 1.03-1.34]), and decreased screen time (aOR: 1.12 [95% CI: 1.02-1.22]).

Conclusions: For children without special health care needs, the medical home is associated with improved health care utilization patterns, better parental assessment of child health, and increased adherence with health-promoting behaviors. These findings support the recommendations of the American Academy of Pediatrics and the Affordable Care Act to extend the medical home to all children.

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FIGURE 1
FIGURE 1
Subject selection.
FIGURE 2
FIGURE 2
Operationalization of the medical home.
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