Medical Home

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

  • Data Resource Center for Child and Adolescent Health (DRC): Medical Home Data Portal. State medical home performance profiles for all children or children with special health care needs. Includes options to search for additional medical home data and links to resources about the medical home. (Data Source: 2007 National Survey of Children's Health)

    National Survey of Children's Health. This survey includes physical and mental health status, access to quality health care, as well as information on the child's family, neighborhood and social context. Survey section 5 covers medical home. Search for state and national data which can be further refined to assess differences by race/ethnicity, income, special health care needs status and a variety of other important demographic and health status characteristics. The survey was conducted in 2003, 2007, and 2011-2012.

    National Survey of Children with Special Health Care Needs. This survey assesses the health and functional status of children with special health care needs including physical, emotional and behavioral health, along with information on access to quality health care, care coordination of services, access to a medical home, transition services for youth, and the impact of chronic condition(s) on the child's family. The survey was conducted in 2001, 2005-2006, and 2009-2010.
  • Healthy People 2020: Maternal, Infant, and Child Health. Two objectives address medical homes:

    (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

Interventions

Further Reading

Related NCEMCH Resources


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