Transcript Medical Home

Medical Home for Children in
Washington State
Washington State Data from the 2003
National Survey of Children’s Health
Teresa Vollan
MCH Assessment
Washington State Department of Health
November 2, 2006
1
Purpose of Medical Home
Data Project
• Examine who has medical home in WA, using
Washington State data from National Survey of
Children’s Health, 2003
• Provide information to the Medical Home
Strategic Planning Group and Interagency
Medical Home Strike team
• Create short stand-alone document on Medical
Home for children (Medical Home Monograph)
2
Definition of Medical Home
“A medical home is not a building, house, or
hospital, but rather an approach to providing
comprehensive primary care. A medical home is
defined as primary care that is accessible,
continuous, comprehensive, family centered,
coordinated, compassionate, and culturally
effective.”
American Academy of Pediatrics
3
National Survey of Children’s
Health (NSCH)
• National random-digit telephone survey
• Administered in 2003-2004, in English and
Spanish
• One child (age 0-17) in each household
randomly selected to be the subject of interview
• Questions on the physical and emotional health
of child and parent
4
National Survey of Children’s
Health (NSCH)
• US had 102,353 interviews
• WA had 1,932 interviews
• Data weighted to represent US and state
population
• Paid for by MCHB, administered by NCHS
2005 data from NS-CSHCN available next year.
5
Medical Home Measure in NSCH1
To have a medical home, child must meet 6
criteria:
1.
Personal doctor or nurse.
•
2.
Answer must be YES.
Received preventive medical care in past 12 months.
•
3.
Answer must be YES.
Family-centered care.
•
Out of three questions answer must average usually/always.
1
Measure developed by the Child and Adolescent Health Measurement
Initiative (CAHMI).
6
Definition of Medical Home in
NSCH
4.
Consistently can get needed care and advice from
personal doctor/nurse.
•
5.
Between two questions, answer must average usually/always.
Consistently able to access specialist care or
services/equipment as needed.
•
6.
Must report NO problem.
Personal doctor/nurse follows up with family after child
gets specialist care, services and/or equipment.
•
Between two questions, answer must average usually/always.
7
What percentage of children have a
Medical Home? (2003 NSCH)
Washington State:
All Children: 48.5% (45.9, 51.1)
CSHCN: 44.8% (38.5, 51.4)
US:
All Children: 46.1% (45.6, 46.7)
CSHCN: 44.2% (42.9, 45.4)
8
Table 1: Characteristics of Children Ages 0-17 by Medical Home Status,
Washington State, 2003 NSCH (N = 1,913)
Had Medical Home
%
95% CI
48.5
Overall percentage
45.9 , 51.1
Race/ethnicity
Non-Hispanic White
49.5
46.5 , 52.6
Non-Hispanic Black
38.5
24.6 , 54.7
Non-Hispanic Asian
48.9
35.4 , 62.6
Hispanic
41.1
34.3 , 48.2
Age of child*
0-4
62.6
57.7 , 67.3
5-9
47.5
42.3 , 52.8
10-14
41.4
36.7 , 46.3
15-17
41.4
35.8 , 47.3
Gender of child
Male
49.4
45.8 , 53.0
Female
47.9
44.1 , 51.7
* p-value < 0.05, based on chi-square test.
9
Table 1: cont.
Had Medical Home
%
95% CI
Poverty status*
< 100% FPL
40.8
100-199% FPL
49.7
200-399% FPL
44.8
> 400% FPL
58.1
Language spoken at home*
English
49.5
Non-English
37.7
Health insurance of child*
Private
52.2
Medicaid or CHIP
45.5
None
25.8
Special Health Care Needs
Yes
44.8
No
49.3
* p-value < 0.05, based on chi-square test.
33.2
43.4
40.2
53.7
,
,
,
,
48.9
56.0
49.4
62.3
46.8 , 52.2
29.4 , 46.7
49.1 , 55.3
40.1 , 51.0
17.6 , 36.2
38.5 , 51.4
46.4 , 52.2
10
Differences in Medical Home by
demographics
Crude analysis:
•
•
•
•
Poverty status
Age of child
Language spoken at home
Health insurance
Multivariate analysis:
• Age and insurance were significant
11
Components of the Medical Home
measure
Table 2: Percent of Children Meeting Medical Home Criteria
Washington State, NSCH 2003
Gets needed care
Personal doctor or nurse*
Easy access to specialist or equipment*
Family-centered
Preventive care in past year*
Follow-up on specialist or equipment
Meet all six criteria of Medical Home measure
CSHCN
(n = 334)
86.6%
92.0%
76.7%
88.6%
92.0%
49.3%
44.8%
non-CSHCN All children
(n = 1,598) (N = 1,932)
90.9%
89.9%
84.7%
86.0%
91.2%
85.3%
83.6%
84.6%
74.5%
77.5%
58.1%
54.4%
49.3%
48.5%
* p-value < 0.05, based on chi-square test.
12
Summary
When examining the populations who have a medical
home, a few demographic differences stand out: health
insurance, poverty, age of child, and language.
The 6 components of medical home range from 55-90% for
all children.
• CSHCN rates were significantly higher in 2 components:
having a personal Dr or nurse and preventive care
• CSHCN significantly lower in 1 component: easy access
to specialty care and services/equipment.
13
Limitations
• AAP definition of medical home is difficult to measure –
the medical home variable used in this analysis may not
be perfect.
• Medical home measure has changed between surveys –
cannot measure over time.
• Survey excludes institutionalized children and families
without telephone.
• Information is reported by parents: recall and bias
(cultural differences)
• Small numbers in some of the analyses.
14
Many thanks to Stacey De Fries and Riley
Peters in the development of this
presentation.
My contact information:
Teresa Vollan, MPH
(360) 236-3566
[email protected]
15
Questions for you
• How will you use this information?
• What other information do you need?
• Would you like to review the Medical
Home monograph?
16