Associations between practice-reported medical homeness and health care utilization among publicly insured children.
BACKGROUND
The patient-centered medical home (PCMH) is widely promoted as a model to improve the quality of primary care and lead to more efficient use of health care services. Few studies have examined the relationship between PCMH implementation at the practice level and health care utilization by children. Existing studies show mixed results.


METHODS
Using practice-reported PCMH assessments and Medicaid claims from child-serving practices in 3 states participating in the Children's Health Insurance Program Reauthorization Act of 2009 Quality Demonstration Grant Program, this study estimates the association between medical homeness (tertiles) and receipt of well-child care and nonurgent, preventable, or avoidable emergency department (ED) use. Multilevel logistic regression models are estimated on data from 32 practices in Illinois (IL) completing the National Committee for Quality Assurance's (NCQA) medical home self-assessment and 32 practices in North Carolina (NC) and South Carolina (SC) completing the Medical Home Index (MHI) or Medical Home Index-Revised Short Form (MHI-RSF).


RESULTS
Medical homeness was not associated with receipt of age-appropriate well-child visits in either sample. Associations between nonurgent, preventable, or avoidable ED visits and medical homeness varied. No association was seen among practices in NC and SC that completed the MHI/MHI-RSF. Children in practices in IL with the highest tertile NCQA self-assessment scores were less likely to have a nonurgent, preventable, or avoidable ED visit than children in practices with low (odds ratio 0.65; 95% confidence interval 0.47-0.92; P < .05) and marginally less likely to have such a visit compared with children in practices with medium tertile scores (odds ratio 0.72, 95% confidence interval 0.52-1.01; P = .06).


CONCLUSIONS
Higher levels of medical homeness may be associated with lower nonurgent, preventable, or avoidable ED use by publicly insured children. Robust longitudinal studies using multiple measures of medical homeness are needed to confirm this observation.
['Christensen|Anna L|AL|', 'Zickafoose|Joseph S|JS|', 'Natzke|Brenda|B|', 'McMorrow|Stacey|S|', 'Ireys|Henry T|HT|']
D000293:Adolescent D002648:Child D002662:Child Health Services D002675:Child, Preschool D065326:Children's Health Insurance Program D004636:Emergency Service, Hospital D005260:Female D006801:Humans D007223:Infant D007231:Infant, Newborn D016015:Logistic Models D008297:Male D008484:Medicaid D055361:Multilevel Analysis D009657:North Carolina D010342:Patient Acceptance of Health Care D018802:Patient-Centered Care D011320:Primary Health Care D013022:South Carolina D014481:United States
medical home child health services health care quality, access, and evaluation patient-centered care primary health care