Health Service Use and Expenditures for CSHCN with a Medical Home

Healthcare expenditures and resources are greater for children with special healthcare needs (CSHCN), but this patient population and their families are often challenged by inferior care coordination, increased financial burden due to medical illness, unmet health needs, and poor health outcomes. The pediatric, family-centered medical home model of primary care has gained momentum as an approach to remedy the shortcomings of a healthcare provider-centric system of care for CSHCN. The medical home aims to provide preventive, acute, and chronic care management within a community-based system of services. Research suggests that among CSHCN, having a medical home may be associated with reduced hospitalizations or emergency department (ED) use. After testing associations between having a medical home and health services use and expenditures among US CSHCN, researchers found few differences in annual health service use and costs between CSHCN with and without a medical home, according to study results reported online in Archives of Pediatrics & Adolescent Medicine [doi:10.1001/archpediatrics.2011.1154]. This cross-sectional analysis of the 2003-2008 Medical Expenditure Surveys included 9816 CSHCN up to 17 years age, including 1056 with functional or sensory limitation and 8760 without a limitation. An estimated 47% of CSHCN had a medical home, whereas only 37% of CSHCN with a limitation had a medical home. Of this patient population, 84% met either 5 or 6 criteria for a medical home. To have a medical home, the child must have a usual source of care (individual or place) and have positive care experiences in reflecting accessible, comprehensive, family-centered, compassionate, and culturally effective care. The primary end points included annual healthcare use (outpatient, inpatient, ED, and dental visits) and cost (outpatient, inpatient, ED, prescription medication, dental, and other healthcare expenditures). This study found that for healthcare use, on average, 88% of CSHCN had at least 1 outpatient visit, 53% had at least 1 preventive care visit, 77% had at least 1 acute care visit, 5% had at least 1 inpatient admission, 1% had at least 1 ambulatory care service inpatient admission, 19% had at least 1 ED visit, and 57% had at least 1 dental visit on an annual basis. In propensity score-adjusted analyses, CSHCN with a medical home had 14% more dental visits than CSHCN without a medical home (incidence rate ratio [IRR], 1.14; 95% confidence interval [CI], 1.03-1.25; P<.01). This finding was significant for CSHCN without limitations (IRR, 1.13; 95% CI, 1.01-1.24; P<.01) but not for those with limitations (IRR, 1.25; 95% CI, 0.97-1.62). The medical home was associated with greater odds of incurring total, outpatient, prescription medication, and dental expenditures (odds ratio, 1.92; 95% CI, 1.45-2.43; P<.001). For CSHCN with a limitation, those with a medical home had reduced annual inpatient costs, compared with those without a medical home (mean, −$968; 95% CI, −$121 to −$1928), and among CSHCN without a limitation, those with a medical home had higher prescription medication costs than those without a medical home (mean, $87; 95% CI, $22-$153). Study results “suggest few significant differences in health service use and annual mean expenditures between CSHCN with and without a medical home. The medical home, however, may be associated with lower inpatient expenditures and higher prescription medication expenditures within subgroups of CSHCN,” the researchers said.