Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA.
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Med Care. 2018 Oct;56(10):840-846. doi: 10.1097/MLR.0000000000000978.
Efforts to transform primary care have been underway for over a decade. Yet, we lack understanding of the progress made in scaling up this care model nationwide and on whether patient-centered medical home (PCMH) has benefited every group of children with special health care needs (CSHCNs).
The main objective of this study was to examine variation in caregiver service experience concordant with PCMH care over time and by child characteristics.
This was a cross-sectional pooled data analysis using the 2003-2012 Medical Expenditures Panel Survey data for CSHCNs, aged 5-17 years. Logistic regressions were implemented, accounting for child and parent sociodemographic, child's health insurance, and contextual characteristics. PCMH concordant care and each component were constructed as binary variables and child functional impairment was measured with the Columbia Impairment Scale.
Thirty-one percent of children reported medical home concordant care; comprehensive (83%) and compassionate (82%) care were most prevalent, and the least common were accessible care (59%) and patient-centered care (60%). PCMH concordant care significantly increased nationwide between 2003 and 2012, but disparities remained based on child needs and sociodemographic characteristics. Multivariate regressions showed variation across medical home components.
Despite increased parent perception of care that is concordant with medical home care over time, disparities remain among high-need CSHCNs. Future research may focus on better understanding how clinical settings tailor this care model, particularly on providing increased access and patient-centered care, to better serve children at the highest need.
十年来，人们一直致力于将初级保健转变为以患者为中心的医疗之家（PCMH）模式。然而，我们并不了解全国范围内扩大这种医疗模式的进展情况，也不了解 PCMH 是否使每一类有特殊医疗需求的儿童（CSHCN）受益。
本研究的主要目的是考察随着时间的推移以及根据儿童特征，照顾者服务体验与 PCMH 护理的一致性变化。
这是一项使用 2003-2012 年医疗支出面板调查数据的 CSHCN（年龄 5-17 岁）的横截面汇总数据分析。实施了逻辑回归，考虑了儿童和父母的社会人口统计学、儿童的健康保险和背景特征。将 PCMH 一致护理和每个组成部分构建为二进制变量，并使用哥伦比亚损伤量表测量儿童的功能障碍。
31%的儿童报告了医疗之家一致的护理；全面（83%）和富有同情心的（82%）护理最为普遍，而可及性护理（59%）和以患者为中心的护理（60%）则最为少见。2003 年至 2012 年间，全国范围内 PCMH 一致护理显著增加，但仍存在基于儿童需求和社会人口统计学特征的差异。多变量回归显示了医疗之家各组成部分的差异。
尽管随着时间的推移，父母对符合医疗之家护理的护理的看法有所增加，但高需求 CSHCN 之间仍存在差异。未来的研究可能集中于更好地了解临床环境如何调整这种护理模式，特别是如何提供更多的可及性和以患者为中心的护理，以更好地为需求最高的儿童服务。
