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The Medical Home, Preventive Care Screenings, and Counseling for Children: Evidence from the Medical Expenditure Panel Survey

Published:August 02, 2010DOI:https://doi.org/10.1016/j.acap.2010.06.010

      Abstract

      Objective

      Little is known about the role of the medical home in promoting essential preventive health care services in the general pediatric population. This study examined associations between having a medical home and receipt of health screenings and anticipatory guidance.

      Methods

      We conducted a cross-sectional analysis of the 2004–2006 Medical Expenditure Panel Survey (MEPS). Our sample included 21 055 children aged 0 to 17 years who visited a health care provider in the year prior to the survey. A binary indicator of the medical home was developed from 22 questions in MEPS, reflecting 4 of the 7 American Academy of Pediatrics' recommended components of the medical home: accessible, family-centered, comprehensive, and compassionate care. Multivariable logistic regression was used to examine the association between the medical home and receipt of specific health screenings and anticipatory guidance, controlling for confounding variables.

      Results

      Approximately 49% of our study sample has a medical home. The medical home, defined when the usual source of care is a person or facility, is significantly associated with 3 health screenings (ie, weight, height, and blood pressure) and several anticipatory guidance topics (ie, advice about dental checkups, diet, exercise, car and bike safety), with odds ratios ranging from 1.26 to 1.54.

      Conclusions

      The medical home is associated with increased odds of children receiving some health screenings and anticipatory guidance. The medical home may provide an opportunity to improve the delivery of these services for children.

      Keywords

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      References

        • Berenson R.A.
        • Hammons T.
        • Gans D.N.
        • et al.
        A house is not a home: keeping patients at the center of practice redesign.
        Health Aff (Millwood). 2008; 27: 1219-1230
        • American Academy of Pediatrics
        The medical home.
        Pediatrics. 2002; 110: 184-186
      1. American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Osteopathic Association. Joint Principles of the Patient-Centered Medical Home. Available at: http://www.medicalhomeinfo.org/downloads/pdfs/jointstatement.pdf. Accessed June 1, 2008.

        • Homer C.J.
        • Klatka K.
        • Romm D.
        • et al.
        A review of the evidence for the medical home for children with special health care needs.
        Pediatrics. 2008; 122: e922-e937
        • Christakis D.A.
        • Feudtner C.
        • Pihoker C.
        • Connell F.A.
        Continuity and quality of care for children with diabetes who are covered by medicaid.
        Ambul Pediatr. 2001; 1: 99-103
        • Christakis D.A.
        • Mell L.
        • Koepsell T.D.
        • et al.
        Association of lower continuity of care with greater risk of emergency department use and hospitalization in children.
        Pediatrics. 2001; 107: 524-529
        • O'Malley A.S.
        • Forrest C.B.
        Continuity of care and delivery of ambulatory services to children in community health clinics.
        J Community Health. 1996; 21: 159-173
        • DeVoe J.E.
        • Petering R.
        • Krois L.
        A usual source of care: supplement or substitute for health insurance among low-income children?.
        Med Care. 2008; 46: 1041-1048
        • Smith P.J.
        • Santoli J.M.
        • Chu S.Y.
        • et al.
        The association between having a medical home and vaccination coverage among children eligible for the vaccines for children program.
        Pediatrics. 2005; 116: 130-139
      2. Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition. Elk Grove Village, IL: American Academy of Pediatrics.

        • Houtrow A.J.
        • Kim S.E.
        • Chen A.Y.
        • Newacheck P.W.
        Preventive health care for children with and without special health care needs.
        Pediatrics. 2007; 119: e821-e828
        • Ma J.
        • Wang Y.
        • Stafford R.S.
        U.S. adolescents receive suboptimal preventive counseling during ambulatory care.
        J Adolesc Health. 2005; 36: 441
        • Perry C.D.
        • Kenney G.M.
        Preventive care for children in low-income families: how well do Medicaid and state children's health insurance programs do?.
        Pediatrics. 2007; 120: e1393-e1401
        • Shenkman E.
        • Youngblade L.
        • Nackashi J.
        Adolescents' preventive care experiences before entry into the State Children's Health Insurance Program (SCHIP).
        Pediatrics. 2003; 112: e533
        • Cook S.
        • Weitzman M.
        • Auinger P.
        • Barlow S.E.
        Screening and counseling associated with obesity diagnosis in a national survey of ambulatory pediatric visits.
        Pediatrics. 2005; 116: 112-116
        • Rand C.M.
        • Auinger P.
        • Klein J.D.
        • Weitzman M.
        Preventive counseling at adolescent ambulatory visits.
        J Adolesc Health. 2005; 37: 87-93
        • Tanski S.E.
        • Klein J.D.
        • Winickoff J.P.
        • et al.
        Tobacco counseling at well-child and tobacco-influenced illness visits: opportunities for improvement.
        Pediatrics. 2003; 111: E162-E167
        • Inkelas M.
        • Newacheck P.W.
        • Olson L.M.
        • Zuckerman B.
        • Schuster M.A.
        Does having a regular primary care clinician improve quality of preventive care for young children?.
        Med Care. 2008; 46: 323-330
        • Schuster M.A.
        • Duan N.
        • Regalado M.
        • Klein D.J.
        Anticipatory guidance: what information do parents receive? What information do they want?.
        Arch Pediatr Adolesc Med. 2000; 154: 1191-1198
        • Olson L.M.
        • Inkelas M.
        • Halfon N.
        • et al.
        Overview of the content of health supervision for young children: reports from parents and pediatricians.
        Pediatrics. 2004; 113: 1907-1916
        • Nelson C.S.
        • Higman S.M.
        • Sia C.
        • et al.
        Medical homes for at-risk children: parental reports of clinician-parent relationships, anticipatory guidance, and behavior changes.
        Pediatrics. 2005; 115: 48-56
        • Agency for Healthcare Quality and Research
        Medical Expenditure Panel Survey.
        (Available at:) (Accessed June 11, 2008)
        • Bethell C.D.
        • Read D.
        • Brockwood K.
        American Academy of Pediatrics. Using existing population-based data sets to measure the American Academy of Pediatrics definition of medical home for all children and children with special health care needs.
        Pediatrics. 2004; 113: 1529-1537
        • Beal A.
        • Hernandez S.
        • Doty M.
        Latino access to the patient-centered medical home.
        J Gen Intern Med. 2009; 24: 514-520
        • Blumberg S.J.
        • Olson L.M.
        • Frankel M.
        • et al.
        Design and operation of the National Survey of Children's Health, 2003.
        Vital Health Stat 1. 2005; 43: 1-124
        • Starfield B.
        • Shi L.
        The medical home, access to care, and insurance: a review of evidence.
        Pediatrics. 2004; 113: 1493-1498
        • Strickland B.
        • McPherson M.
        • Weissman G.
        • et al.
        Access to the medical home: results of the National Survey of Children with Special Health Care Needs.
        Pediatrics. 2004; 113: 1485-1492
        • Child and Adolescent Health Measurement Initiative
        2003 National Survey of Children's Health: Child Health & Health Care Measures SPSS Codebook.
        (Available at:) (Accessed June 8, 2008)
        • Pless C.E.
        • Pless I.B.
        How well they remember. The accuracy of parent reports.
        Arch Pediatr Adolesc Med. 1995; 149: 553-558
        • Ritter P.L.
        • Stewart A.L.
        • Kaymaz H.
        • et al.
        Self-reports of health care utilization compared to provider records.
        J Clin Epidemiol. 2001; 54: 136-141
        • Suarez L.
        • Simpson D.M.
        • Smith D.R.
        Errors and correlates in parental recall of child immunizations: effects on vaccination coverage estimates.
        Pediatrics. 1997; 99: E3
        • D'Souza-Vazirani D.
        • Minkovitz C.S.
        • Strobino D.M.
        Validity of maternal report of acute health care use for children younger than 3 years.
        Arch Pediatr Adolesc Med. 2005; 159: 167-172
        • Andersen R.M.
        Revisiting the behavioral model and access to medical care: does it matter?.
        J Health Soc Behav. 1995; 36: 1-10
        • Irwin Jr., C.E.
        • Adams S.H.
        • Park M.J.
        • Newacheck P.W.
        Preventive care for adolescents: few get visits and fewer get services.
        Pediatrics. 2009; 123: e565-e572
        • Mangione-Smith R.
        • DeCristofaro A.H.
        • Setodji C.M.
        • et al.
        The quality of ambulatory care delivered to children in the United States.
        N Engl J Med. 2007; 357: 1515-1523
      3. U.S. Department of Health and Human Services Health Resources and Services Administration, Maternal and Child Health Bureau. The Health and Well-Being of Children: A Portrait of States and the Nation 2005. Rockville, Md: U.S. Department of Health and Human Services, 2005.

        • Zuckerman B.
        • Stevens G.D.
        • Inkelas M.
        • Halfon N.
        Prevalence and correlates of high-quality basic pediatric preventive care.
        Pediatrics. 2004; 114: 1522-1529
        • Galuska D.A.
        • Fulton J.E.
        • Powell K.E.
        • et al.
        Pediatrician counseling about preventive health topics: results from the Physicians' Practices Survey, 1998–1999.
        Pediatrics. 2002; 109 (E83)