The Maternal and Child Health Bureau (MCHB) Title V Maternal and Child Health Services Block Grants to States Program has established 15 National Performance Measures for the 2015-2017 grant cycle. Performance Measure 11 is the percent of children with and without special health care needs having a medical home. This evidence brief points to a selection of resources for state MCH programs about pediatric medical homes, with emphasis on evidence-based information.
Significance
The Title V Maternal and Child Health Services Block Grant to States Program guidance1 defines the significance of this goal as follows:
The American Academy of Pediatrics (AAP) specifies seven qualities essential to medical home care: accessible, family-centered, continuous, comprehensive, coordinated, compassionate and culturally effective. Ideally, medical home care is delivered within the context of a trusting and collaborative relationship between the child's family and a competent health professional familiar with the child and family and the child's health history. Providing comprehensive care to children in a "medical home" is the standard of pediatric practice. Research indicates that children with a stable and continuous source of health care are more likely to receive appropriate preventive care and immunizations, are less likely to be hospitalized for preventable conditions, and are more likely to be diagnosed early for chronic or disabling conditions. The Maternal and Child Health Bureau uses the AAP definition of "medical home."
Read More about Performance Measure 11
Performance Measure 11
Percent of children with and without special health care needs having a medical home
Goal
To increase the number of children with and without special health care needs who have a medical home
Definition
Numerator: Parent report for all children with and without special health care needs, ages 0 to 18 years, who meet the criteria for having a medical home, with subset analyses for children with special health care needs
Denominator: All children and adolescents, ages 0 to 18 years
Units: 100
Text: Percent
Healthy People 2020 Objectives
Related to Maternal, Infant, and Child Health (MICH) Objectives 30.1: Increase the proportion of children who have access to a medical home, (Baseline: 57.5%, Target: 63.3%) and 30.2: Increase the proportion of children with special health care needs who have access to a medical home. (Baseline: 49.8%, Target: 54.8%)
Related to Maternal, Infant, and Child Health (MICH) Objective 31: Increase the proportion of children with special health care needs who receive their care in family-centered, comprehensive, coordinated systems. (Baseline: 20.4% for children aged 0-11, Target: 22.4%; Baseline: 13.8% for children aged 12 through 17, Target 15.2%)
Data Sources and Data Issues
The revised National Survey of Children's Health (NSCH) beginning in 2017. States can use data from the 2011-2012 NSCH as a baseline.
Data and Statistics
National Survey of Children's Health (NSCH). Funded by the Health Resources and Services Administration's (HRSA's) Maternal and Child Health Bureau (MCHB), this survey provides national and state-level data on the physical and emotional health of American children 0 - 17 years old. Information is collected on factors related to the health and well-being of children, including access to and utilization of health care, receipt of care in a medical home, family interactions, parental health, school and after-school experiences, and neighborhood characteristics.
Since 2003, the NSCH has provided both national and state-level prevalence estimates for a variety of child health and health care indicators. MCHB also fielded the National Survey of Children with Special Health Care Needs (NS-CSHCN) in 2001, 2005-2006, and 2009-2010. Its purpose was to assess the prevalence and impact of special health care needs among children and their families in the U.S. The 2016 NSCH underwent significant redesign and administration changes and differs greatly from the prior survey cycles. From 2016 onward, the purpose of the NSCH remains the same, but the two individual surveys were combined into a single survey conducted every year.
(1) MICH-30 Increase the proportion of children, including those with special health care needs, who have access to a medical home. See Healthy People 2020 Structured Evidence Queries for an automated search of published literature indexed in PubMed and related to this objective.
(2) MICH-31 Increase the proportion of children with special health care needs who receive their care in family-centered, comprehensive, and coordinated systems. See Healthy People 2020 Structured Evidence Queries for an automated search of published literature indexed in PubMed and related to this objective.
Key Websites
National Academy for State Health Policy (NASHP): Medical Home and Patient-Centered Care. Profiles of state efforts to advance medical homes for Medicaid and Children's Health Insurance Program (CHIP) participants. Includes information about strategies states are using to implement and strengthen medical homes: forming partnerships, defining and recognizing medical homes, aligning reimbursement and purchasing, supporting practices, and measuring results. See NASHP's collection of reports about lessons learned from states' experiences.
National Center for Medical Home Implementation (NCMHI). Resources about the medical home approach to high-quality, comprehensive health care for all children, including those with special health care needs. Includes tools for developing and implementing a medical home, training programs and materials, information about the Affordable Care Act and the medical home, and information about national and state initiatives. See Medical Home Initiatives and Resources by State.
Patient Centered Medical Home (PCMH) Resource Center. Evidence-based resources about the medical home and its potential to transform primary care and improve the quality, safety, efficiency, and effectiveness of U.S. health care. Includes a toolbox of methods used to evaluate and refine PCMH models and other health care interventions and papers about designing strong evaluations and developing the evidence base for the medical home model. Also presents an archive of federal PCMH activities and tools and resources for implementing the PCMH model.
Patient-Centered Primary Care Collaborative. Publications about the patient centered medical home including evidence based reports about the impact of the medical home model on health care costs and quality of care. See Mapping the Medical Home Movement for information about public and private programs using patient centered medical homes and enhanced primary care teams in each state. Also includes a database of patient centered primary care training programs.
Policy Recommendations
American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP), and American Osteopathic Association (AOA). 2007. Joint principles of the patient centered medical home. Washington, DC: Patient Centered Primary Care Collaborative.
American Academy of Pediatrics; Medical Home Initiatives for Children With Special Needs Project Advisory Committee. 2002 (reaffirmed 2008). The medical home. Pediatrics 110(1):184-186.
Hadland SE, Long WE. 2014. A systematic review of the medical home for children without special health care needs. Maternal and Child Health Journal 18(4):891-898. View abstract.
Homer C, Klatka K, Romm D, Kuhlthau K, Bloom S, Newacheck P, Van Cleave J, Perrin JM. 2008. A review of the evidence for the medical home for children with special health care needs. Pediatrics 122(4):e922-e937. View abstract.
Association of Maternal and Child Health Programs. 2010. Health reform: What's in it to promote the medical home? Washington, DC: Association of Maternal and Child Health Programs. The report identifies a number of strategies for promoting medical homes at the state and local level.
Toomey SL, Cheng TL, Academic Pediatric Association - American Academy of Pediatrics Workgroup on the Family-Centered Medical Home. 2013. Home visiting and the family-centered medical home: Synergistic services to promote child health. Academic Pediatrics 13(1):3-5. View abstract.
1Health Resources and Services Administration. 2014. Title V Maternal and Child Health Services Block Grant to States Program: Guidance and Forms for the Title V Application/Annual Report, Appendix F, p. 84.
Medical Home: Evidence Brief, 1st ed. (November 2014).
Author: Susan Brune Lorenzo, M.L.S., with contributions from Jolene Bertness, M.Ed., CHES, Beth DeFrancis, M.L.S., and Olivia K. Pickett, M.A., M.L.S., NCEMCH
