title: Associations between practice-reported medical homeness and health care utilization among publicly insured children.
abstract: BACKGROUND
  The patient-centered medical home (PCMH) is widely promoted as a model to improve the quality of primary care and lead to more efficient use of health care services. Few studies have examined the relationship between PCMH implementation at the practice level and health care utilization by children. Existing studies show mixed results.
  
  
  METHODS
  Using practice-reported PCMH assessments and Medicaid claims from child-serving practices in 3 states participating in the Children's Health Insurance Program Reauthorization Act of 2009 Quality Demonstration Grant Program, this study estimates the association between medical homeness (tertiles) and receipt of well-child care and nonurgent, preventable, or avoidable emergency department (ED) use. Multilevel logistic regression models are estimated on data from 32 practices in Illinois (IL) completing the National Committee for Quality Assurance's (NCQA) medical home self-assessment and 32 practices in North Carolina (NC) and South Carolina (SC) completing the Medical Home Index (MHI) or Medical Home Index-Revised Short Form (MHI-RSF).
  
  
  RESULTS
  Medical homeness was not associated with receipt of age-appropriate well-child visits in either sample. Associations between nonurgent, preventable, or avoidable ED visits and medical homeness varied. No association was seen among practices in NC and SC that completed the MHI/MHI-RSF. Children in practices in IL with the highest tertile NCQA self-assessment scores were less likely to have a nonurgent, preventable, or avoidable ED visit than children in practices with low (odds ratio 0.65; 95% confidence interval 0.47-0.92; P < .05) and marginally less likely to have such a visit compared with children in practices with medium tertile scores (odds ratio 0.72, 95% confidence interval 0.52-1.01; P = .06).
  
  
  CONCLUSIONS
  Higher levels of medical homeness may be associated with lower nonurgent, preventable, or avoidable ED use by publicly insured children. Robust longitudinal studies using multiple measures of medical homeness are needed to confirm this observation.
authors.affiliation: Mathematica Policy Research, Washington, DC. Electronic address: achristensen@mathematica-mpr.com.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Christensen
authors.affiliation: Mathematica Policy Research, Ann Arbor, Mich.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Zickafoose
authors.affiliation: Mathematica Policy Research, Washington, DC.
authors.forename: Brenda
authors.initials: B
authors.lastname: Natzke
authors.affiliation: The Urban Institute, Washington, DC.
authors.forename: Stacey
authors.initials: S
authors.lastname: McMorrow
authors.affiliation: Mathematica Policy Research, Washington, DC.
authors.forename: Henry T
authors.initials: HT
authors.lastname: Ireys
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data; D002675:Child, Preschool; D065326:Children's Health Insurance Program; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D055361:Multilevel Analysis; D009657:North Carolina; D010342:Patient Acceptance of Health Care; D018802:Patient-Centered Care; D011320:Primary Health Care / Q000706:statistics & numerical data*; D013022:South Carolina; D014481:United States
keywords: child health services; health care quality, access, and evaluation; medical home; patient-centered care; primary health care