title: A comparison of individual- versus practice-level measures of the medical home.
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.
authors: Division of General Pediatrics, Department of Pediatrics, University of Massachusetts Medical School/UMass Memorial Children's Medical Center, Worcester, Massachusetts; and webb.long@umassmemorial.org.
authors: Webb E
authors: WE
authors: Long
authors: Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts.
authors: Arvin
authors: A
authors: Garg
mesh_terms: D001900:Boston; D002648:Child; D002669:Child Welfare; D003151:Community Health Centers / Q000592:standards*; D003430:Cross-Sectional Studies; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000592:standards*
keywords: medical home; pediatric