The "patient-centered medical home" (PCMH) approach is an important tool for providing coordinated care for the millions of American children with special health care needs.
But most of these special-needs children do not have access to care consistent with the PCMH approach, reports a study in the October issue of Medical Care. The journal is published in the Lippincott portfolio by Wolters Kluwer.
Despite extensive efforts over more than a decade, more than two-thirds of children with special health care needs are not receiving "PCMH-concordant" care, according to the study by Mónica Pérez-Jolles, Ph.D., of the University of Southern California and Kathleen C. Thomas, Ph.D., of University of North Carolina at Chapel Hill.
More Progress Needed in Providing PCMH Care for Kids with Special Needs
Children with special health care needs are those with "a diagnosis of mental illness and the presence of a chronic physical or developmental condition that requires a higher use and range of health services compared to the??????? general population."
A national survey estimated that about 15% of children have special health care needs and that 23% of US families have at least one child with special needs. Because of their complex needs for health care and other services, these children are at risk for fragmented care or duplication of services.
The PCMH approach focused on delivering care that is accessible, family-centered, coordinated, comprehensive, culturally competent, compassionate, and high-quality is an important part of efforts to improve outcomes for children with special health care needs.
In 2002, the American Academy of Pediatrics issued a statement endorsing the PCMH approach for children with special health care needs, stating that "every child deserves a medical home." Drs. Pérez-Jolles and Thomas write, "This study sought to elucidate how much progress have we made on that promise."
Using nationally representative data (the Medical Expenditures Panel Survey) from 2003 to 2013, the researchers analyzed parent/caregiver experience concordant with PCMH care.
The survey included data relevant to four PCMH characteristics: accessible, family-centered, comprehensive, and compassionate care. The authors examined the implementation of PCMH-concordant care overall and across the PCMH characteristics measured.
The findings suggested that only 31% of children with special health care needs were receiving PCMH-concordant care, based on a composite score consisting of total average scores across all four characteristics.
On analysis of individual characteristics, more than 80% of children experienced care that was comprehensive and compassionate, while about 60% received accessible and patient-centered care.