Access to pediatric primary care and utilization of preventive services in Delaware: An epidemiological study of the medical home concept.

Abstract

The American Academy of Pediatrics defined the medical home as a concept rather than a physical location that consists of necessary attributes to ensure delivery of high-quality pediatric care. Unlike primary care, a medical home is specific to children and requires having access to care 24 hours a day and 365 days a year. Health agencies are beginning to implement medical homes without data to support their effectiveness. A measure for medical home is needed to assess potential differences in utilization and health outcomes between children who have functional medical homes and children who do not. Using the Child Quest 2000 questionnaire and survey data, this dissertation addresses problems in access to medical homes in Delaware by creating and subjecting to psychometric validity testing a measure of access to a medical home called the Medical Home Scale (MHS). Two primary relationships are measured. First, the associations between the MHS and immunization coverage at ages 3, 12, and 24 months are measured. Second, the relationships between personal factors, parental perceptions of the child's health, and having a functional medical home are examined. Two independent samples of Delaware children ages 6-36 months were used: a population sample of 495 children from the Delaware birth registry, and a probability proportionate to size (PPS) sample of 323 children from the Nemours children's clinics operated by the duPont Hospital for Children. The MHS was associated with immunization coverage in the population-based sample at ages 12 (p = 0.02) and 24 months (p = 0.001). In the clinic sample, the MHS was associated with immunization coverage at ages 3 (p = 0.001) and 12 months (p = 0.003). The MHS was not associated with parental perceptions of the child's health, but it was modestly associated with parental worry. The major determinants in predicting having a functional medical home is having Medicaid as insurance (OR = 2.0, 95% C.I. = 1.2, 3.3) and being uninsured (OR = 3.2, 95% C.I. = 1.4, 7.3). The MHS may be useful in determining the functionality of medical homes. More work needs to be conducted in further developing the MHS.