Access to after-hours primary care: a key determinant of children\u2019s medical home status

Bing Han,Peggy Guey-Chi Chen,Hao Yu

doi:10.1186/s12913-021-06192-y

Bing Han, Peggy Guey-Chi Chen + Show 1 more

Open Access

https://doi.org/10.1186/s12913-021-06192-y

Copy DOI

Abstract

BackgroundThe medical home (MH) model has been promoted by both the federal and state governments in the United States in recent years. To ascertain American children’s MH status, many studies have relied on a large set of survey items, posing a considerable burden on their parents. We aimed to identify individual survey items or domains that best predict MH status for children and use them to develop brief markers of MH status. We also examined whether the identified items differed by status of special health care needs and by racial/ethnic group.MethodUsing the 9-year data from Medical Expenditure Panel Survey, we examined associations between children’s MH status and individual survey items or domains. We randomly split the data into two halves with the first half (training sample, n = 8611) used to identify promising items, and the second half (validation sample, n = 8779) used to calculate all statistical measures. After discovering significant predictors of children’s MH status, we incorporated them into several brief markers of MH status. We also conducted stratified analyses by status of special health care needs and by racial/ethnic group.ResultsLess than half (48.7%) of the 8779 study children had a MH. The accessibility domain has stronger association with children’s MH status (specificity = 0.84, sensitivity = 1, Kappa = 0.83) than other domains. The top two items with the strongest association with MH status asked about after-hours primary care access, including doctors’ office hours at night or on the weekend and children’s difficulty accessing care after hours. Both belong to the accessibility domain and are one of several reliable markers for children’s MH status. While each of the two items did not differ significantly by status of special health care needs, there were considerable disparities across racial/ethnic groups with Latino children lagging behind other children.ConclusionAccessibility, especially the ability to access health care after regular office hours, appears to be the major predictor of having a MH among children. The ongoing efforts to promote the MH model need to target improving accessibility of health care after regular hours for children overall and especially for Latino children.

Highlights

The medical home (MH) model has been promoted by both the federal and state governments in the United States in recent years
The top two items with the strongest association with MH status asked about after-hours primary care access, including doctors’ office hours at night or on the weekend and children’s difficulty accessing care after hours
Both belong to the accessibility domain and are one of several reliable markers for children’s MH status

Summary

Introduction

The medical home (MH) model has been promoted by both the federal and state governments in the United States in recent years. Recent years have witnessed an increased interest in promoting the pediatric medical home (MH) model, which was defined by the American Academy of Pediatrics (AAP) as “a model of delivering primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective (i.e., the seven defining domains or components of MH) to every child and adolescent [1, 2].”. A practice’s accreditation can be used to define MH status for the patients served at the practice [11,12,13] Whereas this approach measures MH status from the practice perspective, other studies have defined MH status based on health care experiences [6, 7, 14, 15]. Other studies have used the Medical Expenditures Panel Survey to define children’s MH status [7]

Objectives

Methods

Results

Discussion

Conclusion