Department of Pediatrics, Baylor College of Medicine (S Elango), Houston, Tex.
Department of Pediatrics, St. Christopher's Hospital for Children (R Whitmire and RM Turchi), Philadelphia, Pa; Drexel University, Drexel University College of Medicine (R Whitmire and RM Turchi), Philadelphia, Pa; Drexel University, Dornsife School of Public Health (R Whitmire, J Kim, Z Berhane, R Davis, and RM Turchi), Philadelphia, Pa.
Acad Pediatr. 2022 Jan-Feb;22(1):116-124. doi: 10.1016/j.acap.2021.07.010. Epub 2021 Jul 16.
To evaluate family-reported caregiver experiences and health care utilization of patients enrolled in the Pennsylvania Medical Home Program (PA-MHP) statewide practice network and compare results to PA-MHP practices' Medical Home Index (MHI) scores. We hypothesized families enrolled in higher-scoring patient-and-family-centered medical homes (PCMH) on completed MHIs would report decreased caregiver burden and improved health care utilization.
We analyzed surveys completed by families receiving care coordination services in PA-MHP's network and each practice's mean MHI score. A total of 3221 caregivers completed surveys evaluating hours spent coordinating care/week, missed school/workdays, sick visits, and emergency department (ED) visits. A total of 222 providers from 54 participating PA-MHP practices completed the nationally recognized MHI. Family/practice demographics were collected. We developed multivariate logistic regression models assessing independent associations among family survey outcomes and corresponding practices' MHI scores.
Families enrolled in high-scoring PCMHs had decreased odds of spending >1 h/wk coordinating care (odds ratio [OR] 0.82, adjusted OR [aOR]: 0.70, 95% confidence interval [CI] 0.55-0.90), missing workdays in the past 6 months (OR 0.82, aOR: 0.72, 95% CI 0.69-0.97), and ED visits in the past 12 months (OR 0.83, aOR: 0.81, 95% CI 0.65-0.99) in comparison to families enrolled in lower-scoring PCMHs. Families enrolled in higher-scoring PCMHs did not report fewer sick visits despite fewer ED visits, indicating more appropriate health care utilization. High-scoring PCMHs had lower percentages of publicly insured and low-income children.
Higher-scoring PCMHs are associated with decreased caregiver burden and improved health care utilization across diverse PA practices. Future studies should evaluate interventions uniformly improving PCMH quality and equity.
评估宾夕法尼亚州医疗之家计划（PA-MHP）全州实践网络中参与患者的家庭报告的护理人员体验和医疗保健利用情况，并将结果与 PA-MHP 实践的医疗之家指数（MHI）评分进行比较。我们假设在已完成 MHI 的患者和家庭为中心的医疗保健（PCMH）中评分较高的家庭，其护理人员的负担会减轻，并且医疗保健的利用率会提高。
我们分析了在 PA-MHP 网络中接受护理协调服务的家庭完成的调查以及每个实践的平均 MHI 评分。共有 3221 名护理人员完成了评估每周协调护理时间/小时，错过上学/工作日，就诊和急诊（ED）就诊的调查。来自参与 PA-MHP 的 54 个实践中的 222 名提供者完成了全国公认的 MHI。收集了家庭/实践的人口统计学数据。我们开发了多变量逻辑回归模型，以评估家庭调查结果与相应实践的 MHI 评分之间的独立关联。
与评分较低的 PCMH 相比，评分较高的 PCMH 中的家庭参加者每周花在协调护理上的时间> 1 小时的可能性降低（优势比[OR] 0.82，调整后的 OR [aOR]：0.70，95％置信区间[CI] 0.55-0.90），过去 6 个月内错过工作日的可能性降低（OR 0.82，aOR：0.72，95％CI 0.69-0.97），过去 12 个月内就诊 ED 的可能性降低（OR 0.83，aOR：0.81，95％CI 0.65-0.99）。尽管就诊 ED 的次数减少，但参加评分较高的 PCMH 的家庭报告的就诊次数并没有减少，这表明他们的医疗保健利用率更高。评分较高的 PCMH 中，有公共保险和低收入的儿童比例较低。
评分较高的 PCMH 与各种 PA 实践中的护理人员负担减轻和医疗保健利用率提高有关。未来的研究应评估统一提高 PCMH 质量和公平性的干预措施。
