Associations Between Practice-Reported Medical Homeness and healthcare Utilization Among Publicly Insured Children

Christensen A, Zickafoose J, Natzke B, McMarrow S, Ireys H
Source: ACAD PEDIATR
Publication Year: 2014
Population Focus: Medicaid beneficiaries
Demographic Group: Child
Intervention Type: Service redesign
Study Design: Other Study Design
Type of Literature: White
link: https://www.academicpedsjnl.net/article/S1876-2859(14)00429-X/abstract
Abstract

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 healthcare services. Few studies have examined the relationship between PCMH implementation at the practice level and healthcare 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.

Insights Results

Overview of model

  • Medical homeness was not associated with the receipt of age-appropriate well-child visits in any of the three states; associations between nonurgent, preventable, or avoidable emergency department (ED) visits and medical homeness varied
  • Mixed results around the correlation between medical homeness and ED visits could partially be explained by differences between the tools that measure a practice’s medical home qualities (Medical Home Index (MHI) v. National Center for Quality Assurance (NCQA) self-assessment); additional differences could be explained by the State’s Medicaid context and prior incentives for medical home implementation
  • For practices using the NCQA tool in IL, there was no association between medical homeness and well-child care visits; however, practices with high medical homeness and medium medical homeness were less likely to have nonurgent, preventable or avoidable ED visits
  • For practices in NC/SC who completed the MHI, there was no statistically significant association of medical homeness with either well-child visits or ED visits

    Key takeaways/implications

    • Suggested areas for future research: 1) Researchers must design studies that can identify whether mixed medical home outcomes are due to variations in the measures of medical homeness used, actual variations in medical home implementation fidelity or variations in factors not yet measured; and 2) Longitudinal studies that examine a practice’s change over time would be beneficial
    • Limitations: 1) Medical homeness scores were self-reported by practices and not verified externally; 2) Practices volunteered to participate in the demonstration project and therefore there might be selection bias; and 3) The studies does not include publicly insured children enrolled in MCOs
    • NEW SEARCH