Published online October 1, 2008
PEDIATRICS Vol. 122 No. 4 October 2008, pp. e922-e937 (doi:10.1542/peds.2007-3762)
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REVIEW ARTICLE

A Review of the Evidence for the Medical Home for Children With Special Health Care Needs

Charles J. Homer, MD, MPHa,b, Kirsten Klatka, MSWc, Diane Romm, PhDc, Karen Kuhlthau, PhDc,d, Sheila Bloom, MSc, Paul Newacheck, DrPHe, Jeanne Van Cleave, MDd,e and James M. Perrin, MDd,e

a National Initiative for Children's Healthcare Quality, Cambridge, Massachusetts
b Harvard School of Public Health, Boston, Massachusetts
c Center for Child and Adolescent Health Policy, Mass General Hospital for Children, Boston, Massachusetts
d Harvard Medical School, Boston, Massachusetts
e Institute for Health Policy Studies and Department of Pediatrics, University of California, San Francisco, California

CONTEXT. The receipt of health care in a medical home is increasingly touted as a fundamental basis for improved care for persons with chronic conditions, yet the evidence for this claim has not been systematically assessed.

OBJECTIVE. Our goal was to determine the evidence for the federal Maternal and Child Health Bureau recommendation that children with special health care needs receive ongoing comprehensive care within a medical home.

METHODS. We searched the nursing and medical literature, references of selected articles, and requested expert recommendations. Search terms included children with special health care needs, medical home-related interventions, and health-related outcomes. Articles that met defined criteria (eg, children with special health care needs, United States–based, quantitative) were selected. We extracted data, including design, population characteristics, sample size, intervention, and findings from each article.

RESULTS. We selected 33 articles that reported on 30 distinct studies, 10 of which were comparison-group studies. None of the studies examined the medical home in its entirety. Although tempered by weak designs, inconsistent definitions and extent of medical home attributes, and inconsistent outcome measures, the preponderance of evidence supported a positive relationship between the medical home and desired outcomes, such as better health status, timeliness of care, family centeredness, and improved family functioning.

CONCLUSIONS. The evidence provides moderate support for the hypothesis that medical homes provide improved health-related outcomes for children with special health care needs. Additional studies with comparison groups encompassing all or most of the attributes of the medical home need to be undertaken.

Key Words: medical home • special needs children • systematic review • family-centered care

Abbreviations: MCHB—Maternal Child Health Bureau • CSHCN—children with special health care needs • MH—medical home • FCC—family-centered care • CINAHL—Cumulative Index to Nursing and Allied Health Literature • RCT—randomized, controlled trial • NSCSHCN—National Survey of Children With Special Healthcare Needs • BTS—Breakthrough Series Collaborative • PCP—primary care provider • ED—emergency department • PACC—Pediatric Alliance for Coordinated Care • HMO—health maintenance organization • USC—usual source of care

Accepted Jun 6, 2008.


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