Primary Care Quality Improvement Through Patient-Centered Medical Homes and the Impact on Emergency Department Utilization for Children With Autism and Mental Health Disorders.

IF 1.2 4区医学 Q4 HEALTH CARE SCIENCES & SERVICES

Quality Management in Health Care Pub Date : 2024-07-18 DOI:10.1097/QMH.0000000000000452

Li Huang, Jarron M Saint Onge

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Abstract

Background and objectives: To address health care spending growth, coordinated care, and patient-centered primary care, most states in the United States have adopted value-based care coordination programs such as patient-centered medical homes (PCMHs). The objective of this study was to understand the relationship between having access to PCMHs and emergency department (ED) utilization for high cost/need children with autism and children with mental health disorders (MHDs).

Methods: This cross-sectional study included 87 723 children between ages 3 and 17 years in the 2016-2018 National Survey for Children's Health. Multivariate-adjusted logistic regression analyses were used to assess the association between ED and PCMH utilization for children with autism, with MHDs without autism, and others without autism or MHDs. Marginal predictions were used to examine whether PCMH utilization was moderated by health conditions.

Findings: The results showed that children with a PCMH had a 16% reduction in the odds to visit the ED (adjusted odds ratio [aOR] = 0.84; confidence interval [CI], 0.77-0.92; P < .001). When compared with the reference group of children without autism and without MHDs, children with MHDs but without autism had 93% higher odds to visit the ED (aOR = 1.93; CI, 1.75-2.13; P < .001) and children with autism had 35% higher odds to visit the ED (aOR = 1.35; CI, 1.04-1.75; P = .023). Marginal effects results suggested that PCMHs reduced the odds of ED visits the most for children with MHDs without autism and reduced the predicted ED visits from 30.1% to 23.7% (P < .001).

Conclusions: Primary care quality improvement through access to a PCMH reduced ED visits for children, but the effect varied by autism and MHD conditions. Future PCMH efforts should continue to support children with autism and address unmet needs for children with MHDs with a focus on needed care coordination, family-centered care, and referrals.

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通过 "以患者为中心的医疗之家 "提高初级保健质量，以及对自闭症和精神疾病儿童使用急诊室的影响》（Patient-Centered Medical Homes and the Impact on Emergency Department Utilization for Children with Autism and Mental Health Disorders）。

背景与目标：为了解决医疗支出增长、协调护理和以患者为中心的初级护理等问题，美国大多数州都采用了以价值为基础的护理协调计划，如以患者为中心的医疗之家（PCMHs）。本研究的目的是了解自闭症高费用/高需求儿童和精神疾病（MHDs）儿童使用以患者为中心的医疗之家（PCMHs）和急诊科（ED）之间的关系：这项横断面研究纳入了 2016-2018 年全国儿童健康调查中 87 723 名 3 至 17 岁的儿童。多变量调整逻辑回归分析用于评估自闭症儿童、有 MHD 但无自闭症的儿童以及其他无自闭症或 MHD 的儿童使用 ED 和 PCMH 之间的关联。边际预测用于研究 PCMH 利用率是否受健康状况的影响：结果显示，接受 PCMH 治疗的儿童到急诊室就诊的几率降低了 16%（调整后的几率比 [aOR] = 0.84；置信区间 [CI]，0.77-0.92；P < .001）。与无自闭症且无多发性抽动症的参照组儿童相比，有多发性抽动症但无自闭症的儿童到急诊室就诊的几率要高出93%（aOR = 1.93；CI，1.75-2.13；P < .001），而有自闭症的儿童到急诊室就诊的几率要高出35%（aOR = 1.35；CI，1.04-1.75；P = .023）。边际效应结果表明，PCMHs 最大程度地降低了不患有自闭症的 MHD 儿童去急诊室就诊的几率，并将预测的急诊室就诊率从 30.1% 降至 23.7% (P < .001)：结论：通过加入 PCMH 提高初级保健质量可减少儿童的急诊就诊率，但效果因自闭症和 MHD 状况而异。未来的 PCMH 工作应继续支持自闭症儿童，并解决 MHD 儿童未得到满足的需求，重点关注所需的护理协调、以家庭为中心的护理和转诊。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Quality Management in Health Care HEALTH CARE SCIENCES & SERVICES-

CiteScore

1.90

自引率

8.30%

发文量

108

期刊介绍： Quality Management in Health Care (QMHC) is a peer-reviewed journal that provides a forum for our readers to explore the theoretical, technical, and strategic elements of health care quality management. The journal''s primary focus is on organizational structure and processes as these affect the quality of care and patient outcomes. In particular, it: -Builds knowledge about the application of statistical tools, control charts, benchmarking, and other devices used in the ongoing monitoring and evaluation of care and of patient outcomes; -Encourages research in and evaluation of the results of various organizational strategies designed to bring about quantifiable improvements in patient outcomes; -Fosters the application of quality management science to patient care processes and clinical decision-making; -Fosters cooperation and communication among health care providers, payers and regulators in their efforts to improve the quality of patient outcomes; -Explores links among the various clinical, technical, administrative, and managerial disciplines involved in patient care, as well as the role and responsibilities of organizational governance in ongoing quality management.