By Emily Mullin
January 10, 2012

The medical home model has received plenty of praise from the healthcare community about its benefits to elderly and chronically ill patients as well as its potential to lower costs, but its effects on youth, where the medical home idea originated, is a topic that has been largely unstudied.

A December report appearing in Pediatrics, the official journal of the American Academy of Pediatrics, offers insight into how the medical home impacts child patients without special healthcare needs.

The study provides evidence that the medical home is associated with beneficial healthcare utilization, child health and health-promoting behavior outcomes in children without special health needs.

Defined by the AAP, the medical home is a model of care that is “accessible, family-centered, continuous, comprehensive, coordinated, compassionate and culturally effective.” The model was originally conceived for children in 1967, and it was first promoted nationally by the Maternal and Child Health Bureau’s Division of Services for Children with Special Health Care Needs.

So far, the medical home model has proven effective for decreasing the occurrence of emergency department visits and hospitalization rates in children with distinct health needs. But the researchers of the study say the necessity to address its effectiveness for treating child patients without special health needs is critical, especially with the passage of the Patient Protection and Affordable Care Act in 2009, which promotes the medical home for all patients.

Out of the children studied, 58.1 percent were part of a medical home. The study found that the medical home was significantly associated with increased preventive care visits, decreased outpatient sick visits and decreased emergency department sick visits. Children in medical homes were more likely to have excellent or very good health, according to parental assessment, and to exhibit healthy behaviors like always wearing a helmet while riding a bike.

Children who received care within a medical home were more likely to be younger, non-Hispanic and white. They were also more likely to speak English at home and to live in a two-parent family.

Children in households with income at or above 400 percent of the federal poverty level had twice the odds of having a medical home than children living below the federal poverty level. Similarly, children with a parent who was educated beyond the high school level were more than twice as likely to have a medical home than children whose parents did not complete high school.

For children in medical homes, primary care visits in the past 12 months were more common than children not in a medical home.

The study also found that children up to one year old had the strongest association between a medical home and both increased preventive care visits and overall health being ranked as excellent or very good. School-age children, those aged two to five years, had the strongest link between a medical home and fewer emergency department sick visits. Adolescents, children between the ages of 12 and 17 years old, had the greatest association between a medical home and fewer outpatient sick visits.

Healthy behaviors were also exhibited in children who had access to a medical home. For example, the study found that children in medical homes were more likely to be read to daily, get sufficient sleep daily and watch fewer than two hours of television on a daily basis.

While children in a medical home had better overall health than those not in a medical home, there was no strong correlation with missed school days between children in a medical home and children not in one.

The medical home is promoted by the AAP, and the authors of the study say the findings strengthen the organization’s recommendation that all children have access to a medical home.
 

With the advent of federal legislation promoting the medical home model for all children, it is increasingly important that studies further investigate this subject to better understand and improve health care for all children, the researchers noted.

Wide use of the medical home model will likely result in substantial cost reductions, such as cutting down on expensive emergency department visits, and could broaden access to healthcare for the underserved, according to the study.    

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