Maternal and Child Health Research Program

Advancing Applied MCH Research

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(SDAS) National Prevalence of A Quality Medical Home for Vulnerable Children and the Relationship with School Performance and After-School Activity Participation

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Project Number: R40 MC 11270-01
Grantee: University of Southern California
Department/Center: Family Medicine/Community Health
Project Date: 2/1/2009

Final Report

(SDAS) National Prevalence of A Quality Medical Home for Vulnerable Children and the Relationship with School Performance and After-School Activity Participation Final Report (PDF) Exit Disclaimer

Principal Investigator

Gregory D. Stevens, Ph.D.
Assistant Professor of Research
1000 S. Fremont Avenue Unit #80
Alhambra, CA  91803
Phone: 626-457-4049
Email: gstevens@usc.edu

Age

  • Middle Childhood (6-11 years)
  • Adolescence (12-18 years)

Abstract

The aim of this study is to improve health outcomes for vulnerable children with special health care needs (CSHCN). This will be accomplished by assessing the effects of having a high quality medical home on school performance and after-school activity participation among children with asthma, and examining whether this varies by child vulnerability level. New work has validated a method for measuring child vulnerability through the use of child risk profiles. Risk profiles have proven useful in understanding disparities in the receipt of primary care (and a medical home), but little is known about how risk profiles moderate the linkage between having a medical home and outcomes. Researchers have previously linked medical home attributes to better child health care utilization outcomes such as decreased emergency visits and hospitalizations. This proposed study, however, examines whether a quality medical home impacts children's daily lives, specifically how children with asthma are able to attend and perform at school and the degree to which they are able to participate in after-school activities. This study also examines the extent to which State-level policy variables such as Maternal and Child Health Bureau Title V funding allocations and primary health care professional shortages affect these relationships. The study uses nationally representative survey data on over 10,700 children ages 6-17 years with asthma by merging the 2003 and 2007 iterations of the National Survey of Children's Health. Six features that reflect the American Academy of Pediatrics definition of a medical home are measured: access, continuity, comprehensiveness, family-orientation/compassion, coordination, and cultural-competence. Understanding whether a medical home may help to improve child health outcomes and whether this differs by child vulnerability level will provide guidance to policymakers considering policies to enhance access to primary care to improve the well-being of children. MCHB Research Priorities: The proposed project reflects three priorities of MCHB. First, the research addresses Strategic Research Issue #I regarding public health service systems for maternal and child health populations, by examining the medical home model of care and its effects on health-related outcomes for vulnerable children. Second, the research addresses Strategic Research Issue #II regarding the elimination of health disparities, by examining what role a medical home may play in the remediation of disparities in health-related outcomes for vulnerable children identified by race/ethnicity and language spoken, socioeconomic status, health insurance coverage. Third, the proposed research addresses Strategic Research Issue #III regarding health services and systems to assure quality of care, by examining the impact of specific cardinal features of a medical home on health-related outcomes for children.

Publications

Listed is descending order by year published.

Stevens GD, Pickering TA, Laqui SA. Relationship of medical home quality with school engagement and after-school participation among children with asthma. J Asthma. 2010 Nov;47(9):1001-10. PubMed PMID: 20831470.

Stevens GD, Seid M, Pickering TA, Tsai KY. National disparities in the quality of a medical home for children. Matern Child Health J. 2010 Jul;14(4):580-9. PubMed PMID: 19214723.

Stevens GD, Pickering TA, Seid M, Tsai KY. Disparities in the national prevalence of a quality medical home for children with asthma. Acad Pediatr. 2009 Jul-Aug;9(4):234-41. Epub 2009 Mar 28. PubMed PMID: 19608124.

Keywords

Special Health Care Needs, Medical Home, Primary Care, Asthma, School Outcomes & Services, Chronic Illness, Capacity & Personnel

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