Patient-Centered Medical Homes and Preventive Services for Children

Tuesday, June 25, 2019: 11:00 AM
Wilson A - Mezzanine Level (Marriott Wardman Park Hotel)

Presenter: Steven Hill

Co-Author: Samuel Zuvekas

Discussant: Stephen Zuckerman

Research Objective: While some studies have found patient-centered medical homes (PCMHs) are associated with preventive care, others have not. Typical studies analyzed programs specific to a state or payer. We use nationally representative data on household and physician practices matched to PCMH certification lists to examine the association between certified PCMH status and children’s receipt of preventive services.

Study Design: Data on preventive service use are for 4,175 children age 0-17 in the 2015 and 2016 Medical Expenditure Panel Survey (MEPS) linked with the practice characteristics of their usual source of care, which were collected in the MEPS Medical Care Organizations (MEPS-MOS) follow-back survey. PCMH certification was merged on from the National Committee for Quality Assurance (NCQA), Accreditation Association for Ambulatory Health Care (AAAHC), and the Joint Commission (formerly JCAHO). We classified pediatrician, family practice, and other physician practices seen by children into one of 4 hierarchically defined categories: (1) being certified as a PCMH; (2) no PCMH certification but undertaking two activities to improve quality: regularly giving physicians reports on the clinical quality of their care and having an electronic health record (EHR) system that routinely reminds practitioners to provide guideline-based care or screening tests ; (3) no PCMH certification and either providing reminders or reports, but not both; and (4) no PCMH certification, physician reminders, or physician reports.

Child preventive services examined are well child visits, blood pressure checks, and counseling to eat healthy, exercise, use car safety devices and bicycle helmets. We stratify our analyses by age groups 0-5, 6-12, and 13-17 because the recommended frequency of well child visits varies by age.

We regress preventive service measures on our four-level PCMH/EHR hierarchy, controlling for practice size and ownership type; local availability of pediatricians and family practices physicians; and parental education, income and attitudes toward care; and child patient demographics, health, and insurance status. In addition, we construct measures of local area PCMH density and other market conditions as potential instruments for selection into the MEPS-MOS sample (visiting a usual source of care that responded to the MOS) and endogeneous selection of a PCMH practice.

Population Studied: Children and adolescents aged 0-17 in the non-institutionalized US population that visited their office-based usual source of care in 2015 or 2016.

Principal Findings: Approximately 25% of the usual source of care practices visited by children were certified as a PCMH by one of three accreditation bodies, 50% were not certified as PCMHs but were undertaking two activities to improve quality, 18% provided either reminders or reports but not both, and 6% had neither. Preliminary findings suggest strong associations between PCMH certification and well-child visits, blood pressure checks, and physician advice on helmet use, exercise, and eating, particularly among the youngest age group (0-5).

Conclusions: The study finds nationally representative evidence that PCMHs are associated with child preventive services.