Medicaid-Insured Children Treated in “Medical Homes” Use Emergency Department Less Often, According to AHRQ Study

Children covered by Medicaid who receive care in practices that have implemented a patient-centered medical home (PCMH) model may have fewer non-urgent and avoidable visits to emergency departments (EDs), a recent AHRQ-funded study found. PCMHs have been promoted as a way to improve the quality of primary care and result in more efficient use of health care services. To test the model’s benefits, researchers analyzed the relationship between “medical homeness,” or availability of PCMH attributes at the practice level, and non-urgent ED use by children newborn to 18 years old enrolled in Medicaid for 12 months. The study included more than 90,000 children from 64 primary care practices in Illinois, North Carolina and South Carolina that were participating in the Children’s Health Insurance Program Reauthorization Act Quality Demonstration Grant Program. Although medical homeness was not associated with improved access to well-child visits, higher levels of PCMH attributes were associated with lower rates of non-urgent and avoidable ED use by publicly insured children in Illinois. Researchers concluded that additional studies using multiple measures of medical homeness are needed to confirm this observation. The study andabstract were published online in the May-June issue of the journalAcademic Pediatrics.

2015 May-Jun;15(3):267-74. doi: 10.1016/j.acap.2014.12.001.

Associations between practice-reported medical homeness and health care utilization among publicly insured children.

Christensen AL1, Zickafoose JS2, Natzke B3, McMorrow S4, Ireys HT3.

Author information

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.