Huang Li, Saint Onge Jarron M
Author Affiliations: Department of Population Health, University of Kansas Medical Center, Kansas City.
Qual Manag Health Care. 2025;34(1):35-45. doi: 10.1097/QMH.0000000000000452. Epub 2025 Jan 6.
To address health care spending growth, coordinated care, and patient-centered primary care, most states in the United States have adopted value-based care coordination programs such as patient-centered medical homes (PCMHs). The objective of this study was to understand the relationship between having access to PCMHs and emergency department (ED) utilization for high cost/need children with autism and children with mental health disorders (MHDs).
This cross-sectional study included 87 723 children between ages 3 and 17 years in the 2016-2018 National Survey for Children's Health. Multivariate-adjusted logistic regression analyses were used to assess the association between ED and PCMH utilization for children with autism, with MHDs without autism, and others without autism or MHDs. Marginal predictions were used to examine whether PCMH utilization was moderated by health conditions.
The results showed that children with a PCMH had a 16% reduction in the odds to visit the ED (adjusted odds ratio [aOR] = 0.84; confidence interval [CI], 0.77-0.92; P < .001). When compared with the reference group of children without autism and without MHDs, children with MHDs but without autism had 93% higher odds to visit the ED (aOR = 1.93; CI, 1.75-2.13; P < .001) and children with autism had 35% higher odds to visit the ED (aOR = 1.35; CI, 1.04-1.75; P = .023). Marginal effects results suggested that PCMHs reduced the odds of ED visits the most for children with MHDs without autism and reduced the predicted ED visits from 30.1% to 23.7% ( P < .001).
Primary care quality improvement through access to a PCMH reduced ED visits for children, but the effect varied by autism and MHD conditions. Future PCMH efforts should continue to support children with autism and address unmet needs for children with MHDs with a focus on needed care coordination, family-centered care, and referrals.
为应对医疗保健支出增长、协调护理以及以患者为中心的初级护理问题，美国大多数州都采用了以价值为基础的护理协调项目，如以患者为中心的医疗之家（PCMH）。本研究的目的是了解获得PCMH服务与高成本/高需求的自闭症儿童和精神健康障碍（MHD）儿童的急诊部门（ED）利用率之间的关系。
这项横断面研究纳入了2016 - 2018年全国儿童健康调查中的87723名3至17岁的儿童。采用多变量调整逻辑回归分析来评估自闭症儿童、无自闭症的MHD儿童以及无自闭症或MHD的其他儿童的ED就诊与PCMH使用之间的关联。边际预测用于检验PCMH使用是否受健康状况的调节。
结果显示，有PCMH服务的儿童前往ED就诊的几率降低了16%（调整后的优势比[aOR]=0.84；置信区间[CI]，0.77 - 0.92；P<.001）。与无自闭症且无MHD的儿童参照组相比，有MHD但无自闭症的儿童前往ED就诊的几率高93%（aOR = 1.93；CI，1.75 - 2.13；P<.001），而自闭症儿童前往ED就诊的几率高35%（aOR = 1.35；CI，1.04 - 1.75；P = .023）。边际效应结果表明，PCMH对无自闭症的MHD儿童减少ED就诊几率的作用最大，将预测的ED就诊率从30.1%降至23.7%（P<.001）。
通过获得PCMH服务来改善初级护理质量可减少儿童的ED就诊，但效果因自闭症和MHD状况而异。未来PCMH的工作应继续支持自闭症儿童，并关注MHD儿童未满足的需求，重点是所需的护理协调、以家庭为中心的护理和转诊。
