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Note: thesis: Thesis (M. P. H.)--Brown University, 2018
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Abstract: Adolescent Access to Patient-Centered Medical Homes Background: Adolescents have specific health and developmental needs that make access to patient-centered medical homes (PCMH) especially important. We analyzed the distribution of PCMHs among US adolescents and examined whether disparities exist among subgroups. Methods: Data on adolescents ages 12-17 years (n=34,601) from the 2011-2012 National Survey of Children’s Health (NSCH) were used to determine what proportion had access to a PCMH. Multivariable logistic regression was used to calculate the odds of having a PCMH, adjusting for sociodemographic characteristics and special health care needs. Results: While most US adolescents had a usual source of care (91%), only about half (51%) had access to a PCMH. Disparities in the prevalence of PCMHs were seen by race/ethnicity, poverty, and having special health care needs. There were lower adjusted odds in having a PCMH for Hispanic (aOR=0.55, 95% CI=0.45-0.68) and black adolescents (aOR=0.58, 95% CI=0.49-0.69) compared to white adolescents. Uninsured adolescents were less likely to have a PCMH (aOR=0.39, 95% CI=0.31-0.51) compared to those with private insurance. Those living below four times the poverty level had lower adjusted odds of PCMH access. Adolescents with special health care needs had lower adjusted odds (aOR=0.66, 95% CI=0.59-0.75) of having a PCMH compared to adolescents without any special health care needs. Conclusion: PCMH access was lower among minorities, those living in poverty, and those with special health care needs. These disparities in PCMH access among these typically underserved groups call for further study and interventions that would make PCMHs more accessible to all adolescents. Assessing Adolescent Outcomes by Patient Center Medical Home Access Background: Adolescents have specific health and developmental needs that make access to PCMH especially important. Methods: Data on adolescents ages 12-17 years from the 2011-2012 National Survey of Children’s Health (NSCH) were used (n=34,601) to determine what proportion had access to a PCMH. Adolescent outcomes analyzed were preventive care visits, flourishing, school engagement, general health, school attendance, physical activity, preventive dental visits and condition of teeth. Multivariable Poisson regression was used to calculate the risk of having an outcome, adjusting for sex, gender, race/ethnicity, primary language spoken at home, region, insurance, poverty, parental education, family structure and children with special health care needs. All analyses accounted for weighting and complex survey design of the NSCH. Results: Adolescents with PCMH access had 1.04 (95% CI: 1.01, 1.06) times the adjusted risk of having a yearly preventive visit compared to those without PCMH access. Those with medical home access had 1.04 (95% CI: 1.03, 1.07) times the risk of having excellent or very good general health compared to those with no access. Across performance outcomes, those with PCMH access had 1.25 (95% CI: 1.18, 1.33) times the risk of usually or always meeting all three criteria measuring flourishing, 1.06 (1.04, 1.09) times the risk of usually or always meeting the two criteria measuring being engaged in school, and 1.04 (95% CI: 1.01, 1.08) times the risk of missing less than 5 days of school in the past year compared to those without access. Conclusions: Medical home access is independently correlated with adolescents receiving more preventive care and having healthier outcomes. PCMH access may help adolescents get more preventive care, be healthier, and perform better than those without medical home access.
Subject (fast) (authorityURI="http://id.worldcat.org/fast", valueURI="http://id.worldcat.org/fast/00914091")
Subject (fast) (authorityURI="http://id.worldcat.org/fast", valueURI="http://id.worldcat.org/fast/01082238")
Subject (fast) (authorityURI="http://id.worldcat.org/fast", valueURI="http://id.worldcat.org/fast/00796984")
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Identifier: DOI: 10.26300/g3pg-1289
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