Patient-Centered Medical Homes and Pediatric Preventive Counseling

Abstract

Objective: To measure pediatric preventive counseling at patient-centered medical homes (PCMHs) compared with practices that reported undertaking some or no quality-related activities.

Methods: We analyzed 4814 children and adolescents ages 0 to 17 who visited their usual sources of care in the nationally representative Medical Expenditure Panel Survey Medical Organizations Survey (MEPS-MOS), a household survey combined with a survey of household members' usual sources of care. We identified PCMHs using lists from certifying or accrediting organizations. For other practices in the MEPS-MOS, 2 quality-related activities were 1) reports to physicians about their clinical quality of care, and 2) electronic health record system reminders to physicians. Regressions controlled for practice, child, and family characteristics.

Results: Compared with other practices, PCMHs were generally associated with greater likelihood of receiving preventive counseling. Estimates varied with the quality-related activities of the comparison practices. Counseling against smoking in the home was 10.4 to 18.7 percentage points (both P < .01) more likely for PCMHs. More associations were statistically significant for PCMHs compared with practices that undertook 1 of 2 quality-related activities examined. Among children ages 2 to 5, compared with practices undertaking both quality-related activities, those with PCMHs were more likely to receive counseling on 3 of 5 topics. Among adolescents, compared with practices undertaking both quality-related activities, those with PCMHs were more likely to receive counseling on smoking, exercise, and eating healthy.

Conclusions: PCMHs were associated with substantially greater receipt of pediatric preventive counseling. Evaluations of PCMHs need to account for the quality-related activities of comparison practices.

Keywords: patient-centered medical homes.