A Comparison of Individual- Versus Practice-Level Measures of the Medical Home

Authors, Primary Long,W. E.;Garg,A.
Title Primary A Comparison of Individual- Versus Practice-Level Measures of the Medical Home
Periodical Full Pediatrics
Pub Year 2015
Volume 135
issue 3
Start Page 489
Abstract OBJECTIVE: To determine the association between a widely used individual-level assessment of the medical home derived from parental perception and practice-level assessment of the medical home. METHODS: Thirty parents at each of 6 Boston-area community health centers (CHCs) were administered the 19-question medical home measure of the 2011 National Survey of Children's Health (NSCH). Each CHC was scored in accordance with the National Committee for Quality Assurance (NCQA) 2011 Patient-Centered Medical Home Standards and Guidelines. Bivariate analysis of the independent variables against the dependent variable (the NCQA measure, assessed as both a continuous score and a categorical tier) was performed. Linear and logistical regression models accounting for the cluster design were then constructed, with the NSCH measure as the primary predictor. RESULTS: Of the 180 parents, 52% had a medical home according to the NSCH criteria. Of the 6 CHCs, 5 were a medical home according to the NCQA Standards (2 at Tier 3, 3 at Tier 2). Regression modeling demonstrated nonsignificant associations between both the continuous and categorical (tier) NCQA scores and the NSCH assessment of the medical home, with a β of -2.80 (95% confidence interval, -7.75 to 13.35) and an adjusted odds ratio of 2.17 (95% confidence interval, 0.82 to 5.74), respectively. CONCLUSIONS: There was no significant association between the individual-level and practice-level assessments of the medical home. Given this discrepancy, our results suggest that we may need to temper our expectations that the medical home transformation currently being implemented at the practice level will lead to the child health and health care utilization outcomes extensively demonstrated in the literature.
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Reference Type(s) Journal Article
Topic Tag(s) Defining/Evaluating/Qualifying a Medical Home;Outcomes;Implementation
Special Population(s) Children with Special Needs;Children without Special Needs
Case Study No
Commentary/Opinion Piece No
Historical Publication No
Key/Foundational Article No
Literature Review No
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