title: Parents' preferences for enhanced access in the pediatric medical home: a discrete choice experiment.
abstract: OBJECTIVE
  Efforts to transform primary care through the medical home model may have limited effectiveness if they do not incorporate families' preferences for different primary care services.
  
  
  OBJECTIVE
  To assess parents' relative preferences for different categories of enhanced access services in primary care.
  
  
  METHODS
  Internet-based survey that took place with a national online panel from December 8, 2011, to December 22, 2011. Participants included 820 parents of children aged 0 to 17 years. Hispanic and black non-Hispanic parents were each oversampled to 20% of the sample. The survey included a discrete choice experiment with questions that asked parents to choose between hypothetical primary care practices with different levels of enhanced access and other primary care services.
  
  
  METHODS
  We estimated parents' relative preferences for different enhanced access services using travel time to the practice as a trade-off and parents' marginal willingness to travel in minutes for practices with different levels of services.
  
  
  RESULTS
  The response rate of parents who participated in the study was 41.2%. Parents were most likely to choose primary care offices that guaranteed same-day sick visits (coefficient, 0.57 [SE, 0.05]; P < .001) followed by those with higher professional continuity (coefficient, 0.36 [SE, 0.03]; P < .001). Parents were also significantly more likely to choose practices with 24-hour telephone advice plus nonurgent email advice (0.08 [0.04]; P < .05), evening hours 4 or more times a week (0.14 [0.04]; P < .001), and at least some hours on weekends. Parents were significantly less likely to choose practices that were closed during some weekday daytime hours or had wait times longer than 4 weeks for preventive care visits. There was very little variation in preferences among parents with different sociodemographic characteristics. Parents' marginal willingness to travel was 14 minutes (95% CI, 11-16 minutes) for guaranteed same-day sick visits and 44 minutes (95% CI, 37-51 minutes) for an office with idealized levels of all services.
  
  
  CONCLUSIONS
  As primary care practices for children implement aspects of the medical home model, those that emphasize same-day sick care and professional continuity are more likely to meet parents' preferences for enhanced access. Practices should seek to engage families in prioritizing changes in practice services as part of medical home implementation.
authors: Mathematica Policy Research, Ann Arbor, Michigan3Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor.
authors: Joseph S
authors: JS
authors: Zickafoose
authors: Division of General Pediatrics, Johns Hopkins University, Baltimore, Maryland.
authors: Lisa R
authors: LR
authors: DeCamp
authors: Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor.
authors: Lisa A
authors: LA
authors: Prosser
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D002755:Choice Behavior; D034742:Electronic Mail; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D020407:Internet; D008297:Male; D008875:Middle Aged; D010290:Parents; D018802:Patient-Centered Care; D011320:Primary Health Care; D013997:Time Factors; D055815:Young Adult
references: Br J Gen Pract. 2006 Jan;56(522):4-5
references: 16438808
references: J Health Serv Res Policy. 2008 Apr;13 Suppl 2:3-10
references: 18416923
references: Pharmacoeconomics. 2008;26(8):661-77
references: 18620460
references: Health Aff (Millwood). 2008 Sep-Oct;27(5):1219-30
references: 18780904
references: Pediatrics. 2009 Jul;124(1):194-204
references: 19564300
references: Vaccine. 2010 Feb 17;28(7):1702-8
references: 20044060
references: Health Aff (Millwood). 2010 May;29(5):914-20
references: 20439880
references: Ann Fam Med. 2010;8 Suppl 1:S80-90; S92
references: 20530397
references: Health Aff (Millwood). 2010 Jun;29(6):1194-9
references: 20530354
references: Health Aff (Millwood). 2011 Mar;30(3):439-45
references: 21383361
references: Pediatrics. 2013 Apr;131 Suppl 2:S149-59
references: 23547059
references: J Ambul Care Manage. 2013 Jan-Mar;36(1):2-12
references: 23222008
references: Int J Cardiol. 2014 Oct 20;176(3):1220-2
references: 25150485
references: Ambul Pediatr. 2002 Jan-Feb;2(1):38-48
references: 11888437
references: Pediatrics. 2002 Jul;110(1 Pt 1):184-6
references: 12093969
references: Pediatrics. 1979 Mar;63(3):486-90
references: 440850
references: Fam Pract. 1999 Feb;16(1):4-11
references: 10321388
references: Health Econ. 2005 Oct;14(10):1079-83
references: 15852455
references: Health Expect. 2006 Mar;9(1):60-9
references: 16436162
references: Value Health. 2011 Jun;14(4):403-13
references: 21669364
references: Health Serv Res. 2011 Dec;46(6pt2):2057-78
references: 21517835
references: Vaccine. 2012 May 14;30(23):3445-52
references: 22449423
references: J Gen Intern Med. 2012 Nov;27(11):1406-15
references: 22653379
references: J Pediatr. 2013 Nov;163(5):1389-95.e1-6
references: 23759421