The Medical Home Experience of Low-income Children with Non-Urgent Encounters in Acute Care Settings.

PURPOSE: Assess relationships between having a medical home and health care-seeking behavior attitudes among parents of low-income children with non-urgent encounters in acute settings (emergency, urgent care centers). METHODS: We analyzed data from 1,743 publicly insured children within non-urgent encounters. Parents completed surveys assessing medical home access and attitudes regarding health care-seeking behavior. Multivariate logistic regression analyses were conducted to investigate relationships between medical home access and attitudes. RESULTS: Forty percent of children with non-urgent acute care encounters had medical homes. Having a medical home was positively associated with always calling the doctor before going to acute care settings and preference to take a child to their doctor if the doctor's office was open evenings and weekends. CONCLUSIONS: Although having a medical home is associated with positive attitudes regarding health care-seeking behavior, it may not suffice to overcome other barriers that precipitate non-urgentencounters.

Early intervention, IDEA Part C services, and the medical home: collaboration for best practice and best outcomes.

The medical home and the Individuals With Disabilities Education Act Part C Early Intervention Program share many common purposes for infants and children ages 0 to 3 years, not the least of which is a family-centered focus. Professionals in pediatric medical home practices see substantial numbers of infants and toddlers with developmental delays and/or complex chronic conditions. Economic, health, and family-focused data each underscore the critical role of timely referral for relationship-based, individualized, accessible early intervention services and the need for collaborative partnerships in care. The medical home process and Individuals With Disabilities Education Act Part C policy both support nurturing relationships and family-centered care; both offer clear value in terms of economic and health outcomes. Best practice models for early intervention services incorporate learning in the natural environment and coaching models. Proactive medical homes provide strategies for effective developmental surveillance, family-centered resources, and tools to support high-risk groups, and comanagement of infants with special health care needs, including the monitoring of services provided and outcomes achieved.

Association of medical home care and disparities in emergency care utilization among children with special health care needs.

OBJECTIVE: The aim of this study was to determine whether having a medical home is associated with a reduction of racial/ethnic disparities in emergency care utilization by children with special health care needs (CSHCN). METHODS: We conducted a secondary analysis of 35 301 children, aged 0 to 17, from the 2005-2006 National Survey of Children with Special Health Care Needs. The primary dependent variable was emergency care utilization, defined as 1 or more emergency care encounters in the last 12 months. The primary independent variables were race/ethnicity and type of care (medical home, usual source of care, no medical home/no usual source of care). Multiple logistic regression was conducted to investigate associations between race/ethnicity, type of care, and emergency care utilization. RESULTS: Analysis of type of care and its interactions with race/ethnicity showed that non-Hispanic black children with a medical home had higher odds (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.03-1.54) of emergency care utilization compared with non-Hispanic white children with a medical home. The odds of having 1 or more emergency care visits were higher for non-Hispanic black children (OR 1.38, 95% CI 1.22-1.56) compared with non-Hispanic white children after controlling for sociodemographic variables. Having a medical home was associated with lower odds of emergency care utilization (OR 0.81, 95% CI 0.72-0.90) compared with having neither a medical home nor a usual source of care. CONCLUSIONS: Emergency care utilization for CSHCN differed significantly according to race/ethnicity. Having a medical home may be associated with a reduction in disparities in this fragile population.