title: If we build it, who will come? Working-age adults with chronic health care needs and the medical home.
abstract: BACKGROUND
  Currently, there is a call to implement and test the patient-centered medical home in adult populations, particularly among those with chronic conditions. However, the size, composition, and service use of the population who might require this coordinated care model need to be assessed, as does the way they are defined and identified.
  
  
  OBJECTIVE
  Using nationally representative data from the 2002 to 2004 Medical Expenditure Panel Survey, we provide a preliminary profile of the population of working-age adults with chronic health care needs (ACHCN), including those with chronic health conditions and disabilities.
  
  
  RESULTS
  ACHCN comprised the majority (52%) of the working-aged population. Relative to persons without chronic health care needs, they had significantly more service use, access problems, and 4 times more health care expenditures. Of the 2 disability groups within the larger population of ACHCN, those reporting need for help or supervision with activities of daily livings (ADLs) or instrumental ADLs (IADLs) had the highest rates/percentages of the following: mean chronic (3.5) and acute (4.4) conditions during the year, service use (all services), and access problems. The ADL/IADL-limited group reported annual medical expenditures totaling 100 billion dollars, more than what was spent on the entire working-age population without chronic health care needs.
  
  
  CONCLUSIONS
  These data reveal the drawbacks of selecting the potential population targeted for a medical home on the basis of diagnosis alone. New measurement approaches on the basis of shared need for ongoing health and related services are required to bridge the division between disability and chronic health conditions.
authors.affiliation: The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA. gulley@brandeis.edu
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Gulley
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Rasch
authors.forename: Leighton
authors.initials: L
authors.lastname: Chan
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002908:Chronic Disease / Q000453:epidemiology / Q000517:prevention & control; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000458:organization & administration; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D018579:Patient Selection; D018802:Patient-Centered Care / Q000458:organization & administration*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology