Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. 358-364 (doi:10.1542/peds.2008-2600)
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ARTICLE

Improved Outcomes Associated With Medical Home Implementation in Pediatric Primary Care

W. Carl Cooley, MDa,b, Jeanne W. McAllister, BSN, MS, MHAa, Kathleen Sherrieb, DrPH, MSc,d and Karen Kuhlthau, PhDe,f

a Center for Medical Home Improvement, Crotched Mountain Foundation, Greenfield, New Hampshire; Departments of
b Pediatrics
c Psychiatry, Dartmouth Medical School, Hanover, New Hampshire
d Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, White River Junction, Vermont
e Center for Child and Adolescent Health Policy, Massachusetts General Hospital for Children, Boston, Massachusetts
f Department of Pediatrics, Harvard Medical School, Boston, Massachusetts

OBJECTIVE: The medical home model with its emphasis on planned care, care coordination, family-centered approaches, and quality provides an attractive concept construct for primary care redesign. Studies of medical home components have shown increased quality and reduced costs, but the medical home model as a whole has not been studied systematically. This study tested the hypothesis that increased medical homeness in primary care practice is associated with decreased utilization of health services and increased patient satisfaction.

METHODS: Forty-three primary care practices were identified through 7 health plans in 5 states. Using the Medical Home Index (MHI), each practice's implementation of medical home concepts "medical homeness" was measured. Health plans provided the previous year's utilization data for children with 6 chronic conditions. The plans identified 42 children in each practice with these chronic conditions and surveyed their families regarding satisfaction with care and burden of illness.

RESULTS: Higher MHI scores and higher subdomain scores for organizational capacity, care coordination, and chronic-condition management were associated with significantly fewer hospitalizations. Higher chronic-condition management scores were associated with lower emergency department use. Family survey data yielded no recognizable trends with respect to the medical home measurement.

CONCLUSIONS: Developing an evidence base for the value of the primary care medical home has importance for providers, payers, policy makers, and consumers. Reducing hospitalizations through enhanced primary care provides a potential case for new reimbursement strategies supporting medical home services such as care coordination. Larger-scale studies are needed to further develop/examine these relationships.

Key Words: medical home • children with special health care needs • chronic illness • primary care • utilization of health care services • outcomes

Abbreviations: MHI—Medical Home Index • ADHD—attention-deficit/hyperactivity disorder

Accepted Jan 27, 2009.


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