scholarly journals Why Parents Use the Emergency Department Despite Having a Medical Home

2018 ◽  
Vol 58 (1) ◽  
pp. 95-99 ◽  
Author(s):  
Kalpana Pethe ◽  
Allison Baxterbeck ◽  
Susan L. Rosenthal ◽  
Melissa S. Stockwell
Keyword(s):  
Emergency Department ◽  
Low Income ◽  
Medical Home ◽  
Medical Problem ◽  
Community Based ◽  
Phone Line ◽  
Medical Homes ◽  
Medical Home Model ◽  
After Hours ◽  
Publicly Insured

Despite having a medical home, pediatric patients continue emergency department (ED) utilization for various reasons. This study examines parental reasons associated with the decision to seek ED care in a group of low-income, inner-city, publicly insured children. Surveys were conducted with parents of children (age = 0-19 years) presenting to a community-based clinic, which has an established medical home model with enhanced access. Most patients (88.3%) had a pediatrician, and nearly all (93.3%) reported a visit to the ED; most (75.7%) were aware of clinic walk-in hours, but less than half (42.6%) were aware of an after-hours phone line. There was no difference in those who were aware of walk-in hours or an after-hours phone line and a reported ED visit. Half of the parents (52.5%) thought their child’s medical problem was serious. In addition to providing enhanced efforts, medical homes should strive to make families aware of increased access.

Providing a Medical Home: The Cost of Care Coordination Services in a Community-Based, General Pediatric Practice

PEDIATRICS ◽  
2004 ◽  
Vol 113 (Supplement_4) ◽  
pp. 1522-1528 ◽  
Author(s):  
Richard C. Antonelli ◽  
Donna M. Antonelli
Keyword(s):  
Care Coordination ◽  
Medical Home ◽  
Cost Of Care ◽  
Measurement Tool ◽  
Coordinated Care ◽  
Pediatric Practice ◽  
Care Needs ◽  
Community Based ◽  
Medical Home Model ◽  
The Cost

Objective. To determine the cost of unreimbursable care coordination services for children with special health care needs (CSHCN) in 1 community-based, general pediatric practice. Methods. A measurement tool was developed to quantify the precise activities involved in providing comprehensive, coordinated care for CSHCN. Costs of providing this care were calculated on the basis of time spent multiplied by the average salary of the office personnel performing the care coordination service. In addition, data were collected regarding the complexity level of the patient requiring the service, the type of service provided, and the outcome. Results. During the 95-day study period, 774 encounters that led to care coordination activities were logged, representing service provision to 444 separate patients. When these encounters were examined on the basis of clinical complexity of the patient, the most complex patients constituted 11% of the population of CSHCN yet accounted for 25% of the encounters. In addition, care coordination activities for these clinically complex CSHCN engaged office staff 4 times as long when compared with less clinically complex CSHCN. Overall, 51% of the encounters were attributable to coordinating care for problems not considered typically medical and included activities such as processing referrals with managed care organizations, consulting with schools or other educational programs, and providing oversight for psychosocial issues. On the basis of national salary and benefits data, the annual cost of the time spent coordinating care for CSHCN in this medical home model ranged from $22 809 to $33 048 (representing the 25th and 75th percentiles, respectively). Conclusions. The costs of providing care coordination services to CSHCN in a medical home are appreciable but not prohibitive. Standardization of care coordination practices is essential because it makes the medical home more amenable to quality improvement interventions. Mechanisms to finance unreimbursable care coordination activities must be developed to achieve the Healthy People 2010 objective that all CSHCN have access to a medical home.

Patient-Centered Care in a Medical Home

2011 ◽  
Vol 16 (2) ◽  
Author(s):  
Colette Carver ◽  
Anne Jessie
Keyword(s):  
Primary Care ◽  
Medical Home ◽  
The United States ◽  
Patient Centered Care ◽  
Patient Centered Medical Home ◽  
Patient Centered ◽  
Patient Centered Medical Homes ◽  
Medical Homes ◽  
Centered Care ◽  
Medical Home Model

There is general consensus that our current healthcare delivery system will not be able to supply an adequate workforce, contain costs, and meet the ever-increasing chronic-care needs of the growing and aging population in the United States (US). Some of the major challenges to the U.S. healthcare system are faced by those on the front lines, namely the healthcare workers in primary care. Part of the emerging solution for primary care is the adoption of the Patient-Centered Medical Home Model. The intent of this model is to provide coordinated and comprehensive care rooted in a strong collaborative relationship. Carilion Clinic in Southwestern Virginia is implementing this patient-centered model in which a proactive, multidisciplinary care team collectively takes responsibility for each patient. In this article we will elaborate on the concepts of patient-centered care and patient-centered medical homes, after which we will offer an exemplar describing the process that Carilion Clinic is using to establish patient-centered medical homes throughout their primary care departments. Limitations of the Patient-Centered Medical Home Model will also be discussed.

scholarly journals The Emergence Of Specialty Medical Homes In The U.S. Health Care System: Initial Financial Performance Data & The Financial Implications For Provider Organizations

2015 ◽  
Vol 6 (2) ◽  
pp. 91-100
Author(s):  
James Mackie ◽  
Monica Oss
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Care Coordination ◽  
Medical Home ◽  
Health Care Spending ◽  
Medical Specialists ◽  
Medical Homes ◽  
Medical Home Model ◽  
The U.S ◽  
Care System

The U.S. health care system is in the midst of significant change in both service delivery model and financing.     Rising costs are driving payers – public and private alike – to rethink the current financing and care management strategies.  One significant shift in policy is around the structure of care coordination for insured individuals – particularly individuals with complex health service and social support needs.  These individuals, while small in number, are responsible for a large proportion of health care spending.   Traditionally, the care of individuals with complex conditions has been left to a wide range of medical specialists – and rarely been coordinated across all specialties.  But in the past four years, health payers have moved toward ‘integrating’ care coordination with a health care team responsible for all services regardless of specialty. This integrated care coordination model  – referred to as a medical home – has been rapidly adopted by many payers.  And, a specialized version of the medical home model – referred to as a heatlh home or specialty medical home – has been developed for consumers with complex needs.  The model has changed both the relationship of the insured individual to the payer and to their medical specialists. It is early in the adoption of specialty medical homes and two key financial questions are yet unanswered.  The first, do specialty medical homes reduce health care spending for complex consumers.  The second, what are the financial implications of a specialty medical home model for heatlh care provider organizations.  This research examines the available research literature and other published data for preliminary answers to these questions of financial impact of this emerging heatlh care system model. 

scholarly journals Emergency Department Use and Enrollment in a Medical Home Providing After-Hours Care

2018 ◽  
Vol 16 (5) ◽  
pp. 419-427 ◽  
Author(s):  
Tara Kiran ◽  
Rahim Moineddin ◽  
Alexander Kopp ◽  
Eliot Frymire ◽  
Richard H. Glazier
Keyword(s):  
Emergency Department ◽  
Medical Home ◽  
Emergency Department Use ◽  
After Hours Care ◽  
After Hours

Improving Postpartum Attendance among Women with Gestational Diabetes Using the Medical Home Model of Care

2021 ◽  
Author(s):  
Marti D. Soffer ◽  
Patricia Rekawek ◽  
Stephanie Pan ◽  
Jessica Overbey ◽  
Joanne Stone
Keyword(s):  
New York ◽  
Medical Home ◽  
Future Research ◽  
Attendance Rate ◽  
Glucose Testing ◽  
Shared Space ◽  
Key Points ◽  
Medical Home Model ◽  
Women And Children ◽  
Publicly Insured

Objective Poor attendance at the 6-week postpartum (PP) visit has been well reported. Attendance at this visit is crucial to identify women who have persistent diabetes mellitus (DM) following pregnancies affected by gestational DM (GDM). The medical home model has eliminated barriers to care in various other settings. This study sought to improve PP attendance among women with GDM by jointly scheduling PP visits and the 2-month well infant visits. Study Design All patients with a diagnosis of GDM who received care at a New York City–based publicly insured hospital clinic and delivered between October 2017 and June 2019 were eligible. Data were obtained via chart review. The primary outcome was attendance at the PP visit compared with previously published historical controls. Secondary outcomes were rates of PP glucose screening and well infant attendance. Results Of the 74 patients enrolled, 41.9% were Hispanic and 17.6% were Black, mean age was 31.6 years, and 58.1% delivered vaginally. Attendance at the 6-week PP visit was 68.9%, and attendance at the infant visit was 55.1%. PP glucose testing was ordered for 76.5% of attendees at the PP visit, and of those ordered, 43.6% of attendees completed testing. All patients had joint visits requested, though only 70.3% of visits were scheduled jointly. Among those who were jointly scheduled, 71.2% of women attended, 57.7% of infants attended, and 7.7% of pairs attended on the same day. The PP visit attendance rate was not significantly different than the prior attendance rate (p = 0.84). Conclusion This study was unable to improve PP visit attendance among women with GDM by jointly scheduling the 6-week PP visit and the 2-month well-infant visit. Future research could be directed toward a shared space where both women and children can be seen to attempt to increase PP visit attendance and monitoring for women with GDM. Key Points

scholarly journals Multilevel Pathways of Colorectal Cancer Screening Among Low-Income Vietnamese Americans: A Structural Equation Modeling Analysis

2021 ◽  
Vol 28 ◽  
pp. 107327482110110
Author(s):  
Grace X. Ma ◽  
Lin Zhu ◽  
Timmy R. Lin ◽  
Yin Tan ◽  
Phuong Do
Keyword(s):  
Health Beliefs ◽  
Low Income ◽  
Self Efficacy ◽  
Limited English Proficiency ◽  
Structural Equation ◽  
Vietnamese Americans ◽  
Equation Modeling ◽  
Community Based ◽  
Related Factors ◽  
Crc Screening

Background: Colorectal cancer (CRC) disproportionately affects Vietnamese Americans, especially those with low income and were born outside of the United States. CRC screening tests are crucial for prevention and early detection. Despite the availability of noninvasive, simple-to-conduct tests, CRC screening rates in Asian Americans, particularly Vietnamese Americans, remain suboptimal. The purpose of this study was to evaluate the interplay of multilevel factors – individual, interpersonal, and community – on CRC screening behaviors among low-income Vietnamese Americans with limited English proficiency. Methods: This study is based on the Sociocultural Health Behavior Model, a research-based model that incorporates 6 factors associated with decision-making and health-seeking behaviors that result in health care utilization. Using a community-based participatory research approach, we recruited 801 Vietnamese Americans from community-based organizations. We administered a survey to collect information on sociodemographic characteristics, health-related factors, and CRC screening-related factors. We used structural equation modeling (SEM) to identify direct and indirect predictors of lifetime CRC screening. Results: Bivariate analysis revealed that a greater number of respondents who never screened for CRC reported limited English proficiency, fewer years of US residency, and lower self-efficacy related to CRC screening. The SEM model identified self-efficacy (coefficient = 0.092, P < .01) as the only direct predictor of lifetime CRC screening. Educational attainment (coefficient = 0.13, P < .01) and health beliefs (coefficient = 0.040, P < .001) had a modest significant positive relationship with self-efficacy. Health beliefs (coefficient = 0.13, P < .001) and educational attainment (coefficient = 0.16, P < .01) had significant positive relationships with CRC knowledge. Conclusions: To increase CRC screening uptake in medically underserved Vietnamese American populations, public health interventions should aim to increase community members’ confidence in their abilities to screen for CRC and to navigate associated processes, including screening preparation, discussions with doctors, and emotional complications.

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