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The Patient-Centered Medical Home, Practice Patterns, and Functional Outcomes for Children with Attention Deficit/Hyperactivity Disorder

  • Sara L. Toomey
    Correspondence
    Address correspondence to: Sara L. Toomey, MD, MPhil, MPH, MSc, Division of General Pediatrics, Children’s Hospital Boston, 300 Longwood Avenue, Boston, Massachusetts 02115.
    Affiliations
    Division of General Pediatrics, Department of Medicine (Drs Toomey and Schuster, Ms Ratner), Children’s Hospital Boston; Division of Developmental Medicine, Department of Medicine, Children’s Hospital Boston (Dr Chan); and Department of Pediatrics, Harvard Medical School (Drs Toomey, Chan, and Schuster), Boston, Mass
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  • Eugenia Chan
    Affiliations
    Division of General Pediatrics, Department of Medicine (Drs Toomey and Schuster, Ms Ratner), Children’s Hospital Boston; Division of Developmental Medicine, Department of Medicine, Children’s Hospital Boston (Dr Chan); and Department of Pediatrics, Harvard Medical School (Drs Toomey, Chan, and Schuster), Boston, Mass
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  • Jessica A. Ratner
    Affiliations
    Division of General Pediatrics, Department of Medicine (Drs Toomey and Schuster, Ms Ratner), Children’s Hospital Boston; Division of Developmental Medicine, Department of Medicine, Children’s Hospital Boston (Dr Chan); and Department of Pediatrics, Harvard Medical School (Drs Toomey, Chan, and Schuster), Boston, Mass
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  • Mark A. Schuster
    Affiliations
    Division of General Pediatrics, Department of Medicine (Drs Toomey and Schuster, Ms Ratner), Children’s Hospital Boston; Division of Developmental Medicine, Department of Medicine, Children’s Hospital Boston (Dr Chan); and Department of Pediatrics, Harvard Medical School (Drs Toomey, Chan, and Schuster), Boston, Mass
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Published:October 04, 2011DOI:https://doi.org/10.1016/j.acap.2011.08.010

      Abstract

      Objective

      To determine whether children with attention deficit/hyperactivity disorder (ADHD) receive care in a patient-centered medical home (PCMH) and how that relates to their ADHD treatment and functional outcomes.

      Methods

      Cross-sectional analysis of the 2007 National Survey for Children’s Health, a nationally representative survey of 91,642 parents. This analysis covers 5169 children with parent-reported ADHD ages 6–17. The independent variable is receiving care in a PCMH. Main outcome measures are receiving ADHD medication, mental health specialist involvement, and functional outcomes (difficulties with participation in activities, attending school, making friends; having problem behaviors; missed school days; and number of times parents contacted by school).

      Results

      Only 44% of children with ADHD received care in a PCMH. Children with ADHD receiving care in a PCMH compared with those who did not were more likely to receive medication for ADHD (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1–1.9); less likely to have mental health specialist involvement (OR, 0.6; 95% CI, 0.4–0.7); less likely to have difficulties participating in activities (OR, 0.6; 95% CI 0.4–0.8), making friends (OR, 0.6; 95% CI, 0.5–0.9), and attending school (OR, 0.4; 95% CI, 0.3−06); less likely to have problem behaviors (OR 0.6; 95% CI 0.5–0.9); had fewer missed school days (β = −1.5, 95% CI −2.4 to −0.5); and parents were contacted by school less frequently (β = −0.2, 95% CI −0.3 to −0.1).

      Conclusions

      For children with ADHD, receiving care in a PCMH is associated with practice pattern change and better outcomes. The PCMH may represent a promising opportunity to improve quality of care and outcomes for children with ADHD.

      Keywords

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