(SDAS) National Prevalence of A Quality Medical Home for Vulnerable Children and the Relationship with School Performance and After-School Activity Participation
Project Number: R40 MC 11270-01 Project Date: 2/1/2009 Grantee: University of Southern California Department/Center: Family Medicine/Community Health
Final Report
Pending
Principal Investigator
Gregory D. Stevens Ph.D., Assistant Professor of Research, University of Southern California Family Medicine/Community Health, 1000 S. Fremont Avenue Unit #80 Alhambra, CA 91803 gstevens@usc.edu
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
Pending
Keywords
medical home, primary care, children with special health care needs
