title: Effects of a medical home program for children with special health care needs on parental perceptions of care in an ethnically diverse patient population.
abstract: The Pediatric Medical Home Program at UCLA enrolled 41 patients in a primary care model focused on providing intensive care coordination for medically complex, ethnically diverse children with special health care needs (CSHCN) in our Pediatric Resident Continuity clinic. We sought to determine the effect of our program on parental satisfaction, and to compare differences in parental satisfaction between English and Spanish speaking patients. The Medical Home Family Index, developed by the Center for Medical Home Improvement, was administered to a total of 22 participating parents, in the family's primary language by a native speaker, at various times after enrollment in the program. Survey data and language effects were analyzed. The 36 standardized mean scores for the 15 Spanish speaking families were significantly higher (8.5 points higher) than the mean scores from the seven English speaking families (p = 0.003). Although no statistically significant differences were noted in individual questions between Spanish and English speakers, a trend towards more positive responses by Spanish speakers was noted in questions regarding physician-patient communication (p = 0.054) and family-centeredness (p = 0.053). Our results suggest that a primary care model focused on providing intensive care coordination produces positive parental perceptions of the organization and delivery of primary care services in a medically complex population of CSHCN. The main finding of the study is that utilizing the AAP's approach to the medical home model, emphasizing family-centered and culturally competent care, can produce higher satisfaction scores in Spanish speaking parents when compared to English speaking parents.
authors.affiliation: Department of Pediatrics, Mattel Children's Hospital, UCLA Children's Health Center, 200 UCLA Medical Plaza, Suite 265, Los Angeles, CA 90095, USA. Leslie.J.Hamilton@kp.org
authors.forename: Leslie J
authors.initials: LJ
authors.lastname: Hamilton
authors.forename: Carlos F
authors.initials: CF
authors.lastname: Lerner
authors.forename: Angela P
authors.initials: AP
authors.lastname: Presson
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Klitzner
mesh_terms: D000293:Adolescent; D002662:Child Health Services / Q000458:organization & administration / Q000706:statistics & numerical data; D002675:Child, Preschool; D003258:Consumer Behavior; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D010290:Parents / Q000523:psychology*; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D010372:Pediatrics; D010465:Perception; D015397:Program Evaluation; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors