More than two-thirds of children with special healthcare needs don’t have access to care consistent with the “patient-centered medical home (PCMH) approach, researchers estimate in a recent study.
The study, conducted by Mónica Pérez-Jolles, PhD, of University of Southern California and Kathleen C. Thomas, PhD, MPH, of University of North Carolina at Chapel Hill, was published recently in Medical Care, published in the Lippincott portfolio by Wolters Kluwer.
Children with special healthcare needs are those with “a diagnosis of mental illness and/or the presence of a chronic physical or developmental condition that requires a higher use and range of health services compared to the general population,” explains a media release from Wolters Kluwer Health.
Because of their complex needs for healthcare and other services, these children are at risk for fragmented care or duplication of services. The PCMH approach—focused on delivering care that is accessible, family-centered, coordinated, comprehensive, culturally competent, compassionate, and high-quality—is an important part of efforts to improve outcomes for children with special healthcare needs.
In 2002, the American Academy of Pediatrics issued a statement endorsing the PCMH approach for children with special healthcare needs, stating that, “every child deserves a medical home.” Drs Pérez-Jolles and Thomas write, “This study sought to elucidate how much progress have we made on that promise.”
Using nationally representative data (the Medical Expenditures Panel Survey) from 2003 to 2013, the researchers analyzed parent/caregiver experience concordant with PCMH care. The survey included data relevant to four PCMH characteristics: accessible, family-centered, comprehensive, and compassionate care. The authors examined the implementation of PCMH-concordant care overall and across the PCMH characteristics measured, the release explains.
The findings suggest that only 31% of children with special healthcare needs were receiving PCMH-concordant care, based on a composite score consisting of total average scores across all four characteristics. On analysis of individual characteristics, more than 80% of children experienced care that was comprehensive and compassionate, while about 60% received accessible and patient-centered care.
About 87% of children with special healthcare needs had at least moderate functional impairment. These children were less likely to experience PCMH-concordant care—especially those with a high level of functional impairment. Several other characteristics were also linked to lower levels of PCMH-concordant care, including non-white race/ethnicity, lower parental education, low household income, living in a home where English is a second language, and being uninsured or on public health coverage. There were also significant differences by metropolitan area and region.
“Overall, our results showed that just under a third of children with special healthcare needs reported experiencing PCMH-concordant care and there was high variation across components,” Pérez-Jolles and Thomas write, the release continues. “Thus, despite strong support for this care model, we still have a long way to go to reach ‘every child’…with implementation of [PCMH care].”
“Despite increased parent perception of care that is concordant with medical home care over time, disparities remain among high-need children with special healthcare needs,” they conclude.
The authors believe their findings may be useful in tracking special-needs children at higher risk of healthcare inequities, and in tailoring PCMH care to meet the unique needs of these subgroups, they note in the release.
[Source(s): Wolters Kluwer Health, EurekAlert]
