Browsing by keyword "RADx Clinical Studies Core team and Test Us At Home Investigators"
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A comparison of individual- versus practice-level measures of the medical homeOBJECTIVE: 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 beta 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.
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Association between Practice Participation in a Pediatric-focused Medical Home Learning Collaborative and Reduction of Preventable Emergency Department Visits by Publicly-insured Children in MassachusettsIntroduction: This study evaluates the impact of practice participation in a pediatric patient-centered medical home learning collaborative on preventable emergency department (ED) visits among children in MassHealth (Massachusetts Medicaid/Children's Health Insurance Program). Methods: Claims and enrollment data were extracted for child MassHealth members (aged 3–18) comprising 2 groups: members enrolled in a group of 13 child-serving practices that participated in an intensive, 29-month long patient-centered medical home learning collaborative (intervention group), and members enrolled in a group of 12 comparison practices with roughly similar panel size, type, and geographic location (comparison group). Preventable ED visits were identified using a modified version of the New York University ED algorithm. Two analyses were then conducted: (1) a repeat cross-sectional analysis among children enrolled in intervention or comparison group practices during baseline (first half of 2011) and follow-up (second half of 2013) periods; and (2) a longitudinal analysis among a subset of children enrolled for the full study period (2011–2013). Both analyses tested whether the effect of the intervention differed for children with versus without chronic conditions (effect modification). Results: Preventable ED visits declined from baseline to follow-up among children in both intervention and comparison practices. In the cross-sectional analysis, the decrease was the same in both practice groups, and for children with versus without chronic conditions. The longitudinal analysis shows a statistically significantly greater decrease among children with chronic conditions enrolled in the intervention practices (P = 0.02). Conclusion: Children with chronic conditions might receive the greatest benefit from receiving care in a medical home setting.
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Family-Centered Care for Children With Autism Spectrum Disorders: A ReviewMuch has been written about family-centered care (FCC) as a best practice for children with special health care needs. There is limited research on the extent to which children with autism spectrum disorders and their families receive FCC or to delineate what elements of FCC are particularly important to meet their needs. We will examine the extant literature on FCC as a collaborative and empowering practice, the perceptions of parents of children with disabilities about FCC in both the healthcare and education fields, and will review the limited research on the specific needs of families that have a child with ASD. As part of this review, we will identify future directions for research and practice in caring for children with ASD and their families.
