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Riley, M., Laurie, A. R., Plegue, M. A., & Richardson, C. R. (2016). The adolescent “expanded medical home”: School-based health centers partner with a primary clinic to improve population health and mitigate social determinants of health. Journal of the American Board of Family Medicine, 29(3), 339–347.

Link: https://www.ncbi.nlm.nih.gov/pubmed/27170791

NPM: 11: Medical Home
Intervention Components (click on component to see a list of all articles that use that intervention): SCHOOL, School-Based Health Centers, PROVIDER/PRACTICE, Patient-Centered Medical Home, Nurse/Nurse Practitioner, PATIENT/CONSUMER, Referrals, Peer Counselor

Intervention Results:

• The number of shared patients increased from an average of 16 seen per month at baseline to 24 per month during the intervention reflecting a statistically significant increase in the proportion of shared patients from 13% at baseline (192 of 1471) to 19% (240 of 1275) at follow-up. • In terms of the quality measures, patients seen in the expanded medical home had higher compliance with most quality metrics compared to those at the clinic only with nutrition and physical activity counseling being statistically significant. • Adolescents seen at both an SBHC and by a PCP had better adherence with preventive and chronic disease management quality measures at baseline than those seen by a PCP alone. These shared patients had increased frequency of well-child visits and associated preventive services, in addition to improved completeness of care for asthma and obesity. • When appropriate, follow-up after PCP encounters were coordinated to occur at the SBHC, decreasing time away from school and averting a potential loss of parental income to attend multiple visits.

Brown, C. M., Perkins, J., Blust, A., & Kahn, R. (2015). A neighborhood-based approach to population health in the pediatric medical home. Journal of Community Health, 40(1), 1–11.

Link: https://www.ncbi.nlm.nih.gov/pubmed/24923727

NPM: 11: Medical Home
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Patient-Centered Medical Home, CAREGIVER, Home Visit (caregiver), PATIENT/CONSUMER, Home Visits, Outreach (caregiver), Nurse/Nurse Practitioner, Enabling Services

Intervention Results:

This collaborative, neighborhood-based approach led to: • More timely well-child care, • Confirmed enrollment in home visiting, and • Improved communication between the medical home and home visitors. More specifically: • When reliably performed, outreach by care coordinators to low-income families resulted in improvement in timely newborn, 2, and 4-month visits to primary care. • The interventions in Clinic 1 led to a 30% drop in age at the first attended newborn visit among infants from the intervention neighborhood and demonstrated increased timeliness of the newborn visit (from a mean of 14.4 days to a mean of 10.1 days). Infants from the comparison neighborhood showed no reduction in variation or decrease in mean age. • Changes led to a median percentage increase for on-time 2-month well-child visits from 68% to 79% (a relative 16% increase). No improvement was seen among infants from the comparison neighborhood during the same time period. • Clinic 1 saw a significant increase in the monthly percentage of patients in the intervention neighborhood from a median of 35% to 59% (a relative 69% increase). Again, no improvement was seen among infants from the comparison neighborhood during the same time period. • Clinic 1 developed a reliable process for making and tracking referrals and for establishing two-way communication between the home visiting program and clinic that led to the confirmed enrollment of 18 families in the home visiting program (out of 33 eligible families). • Clinic 2 saw a decrease in mean age at newborn visit from 14.8 to 7.2 days, a 51% decrease. The median percentage of on-time 2- and 4-month well child visits remained at 80% and 60%, respectively, throughout the data collection period, and 22 families were enrolled in the Care Team Approach. • Clinic 3 showed reduction in variation and mean age in days at first newborn appointment from 13.3 to 9.1, a 32% decrease. Clinic 3 had a median of 80% on-time for the 2-month well-child visit and 40% on-time for the 4-month well-child visit. The study team was unable to demonstrate improvement in the 2- and 4-month visit timeliness during the immediate post-intervention period. • Clinic 4 was unable to create a system for quantitative data collection on visit adherence or home visiting enrollment specifically for infants from the intervention neighborhood.

Tataw, D. B., Bazargan-Hejazi, S., & James, F. (2011). Health services utilization, satisfaction, and attachment to a regular source of care among participants in an urban health provider alliance. Journal of Health and Human Services Administration, 34(1), 109–141.

Link: https://www.ncbi.nlm.nih.gov/pubmed/21847878

NPM: 11: Medical Home
Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PROVIDER/PRACTICE, Patient-Centered Medical Home, Educational Material (Provider), Continuity of Care (Caseload), CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), PATIENT/CONSUMER, Referrals, Other Education

Intervention Results:

The SCHCA pilot program resulted in the following outcomes: • After two years of community outreach services, 404 outreach events were completed reaching 11,533 children. • Two years of community outreach efforts led to 80,000 children (10% of the children in the service area), who previously did not have a regular source of care being attached to a medical home and 8,545 children being enrolled in available payer sources. • The growth in new patients for the downtown Los Angeles primary care location averaged 50% in the first two years before leveling off in the third year. • In the Compton primary care location, the growth was about 200% annually. • Sub-specialty referral completion rate increased from 25% in 2001 to 78% in 2002, and 80% in 2003 then fell to 20% in 2004. • The difference between the time a pediatric sub-specialty appointment was made and the time the patient was seen reduced from four months in 2001 to two and a half months in 2002, and one month in 2003, before rising to nine months in 2004. The program evaluation demonstrated that: • The majority of the respondents reported less difficulty to obtain medical care (48.4%), less difficulty to obtain routine checkups for their children (58%), and less difficulty to obtain referral (48%) compared to 12 months ago. • The majority of respondents reported being more satisfied compared to 12 months ago with the services received for their children including general medical care (52%), routine check-up (48%), and were holding the same level of satisfaction with sub-specialty services in comparison to the last 12 months (44%).

Jaudes, K. P., Champagne, V., Harden, A., Masterson, J., Bilaver, L. A. (2012). Expanded medical home model works for children in foster care. Child Welfare, 91(1), 9–33.

Link: https://www.ncbi.nlm.nih.gov/pubmed/22894013

NPM: 11: Medical Home
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Outreach (Provider), Patient-Centered Medical Home, Expert Support (Provider), STATE, Collaboration with Local Agencies, Continuity of Care (Caseload)

Intervention Results:

With regard to use of health care services consistent with the medical home model of care: • The children in foster care showed levels of medical attention, though slightly lower than ideal, that were substantially higher than children from the Medicaid only group. More specifically: - Children in foster care had annual well-child visits in 85% of the cases and annual dental care encounters in 66% of the cases. - However, children in foster care were more likely to have general inpatient experiences (3.7% vs. 1.9%) and psychiatric inpatient episodes (7.8% vs. 0.5%). - Children in foster care also had more ED visits (36.1% vs. 29.7%). • Immunization data revealed that approximately 80% of children in foster care were current with their immunizations. • Controlling for population differences in race and ethnicity, age, region of the state, gender, and year70 for children in foster care compared to children in Medicaid, children in foster care were: - 3.58 times more likely to have an Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) exam. - 3.2 times more likely to see a dentist. - 1.39 times more likely to experience a visit to the ED. - 1.8 times more likely to have a general inpatient stay. - Over 13 times more likely to have a psychiatric inpatient stay. • Controlling for chronic conditions accounted for the fact that children in foster care have poorer health than Medicaid only children. Chronic conditions may act as a stimulus to finding and obtaining medical care. - For preventive medical services, the inclusion of chronic conditions actually reduced the differences between the groups slightly, although the children in foster care still show much higher levels of care: • Children in foster care were three times more likely to have an EPSDT exam. • Children in foster care were three times as likely to see a dentist. - For general inpatient stays, the odds ratio was reduced from 1.83 to 1.11. - For psychiatric hospitalization, the control dropped in half from 13.22 to 6.05. - For ED visit, the odds ratio decreased from 1.39 to 1.06. Caregivers were also surveyed about the effectiveness of the model and 95% reported that their children in foster care were in good, very good, or excellent health and 88% received a well-child visit with a pediatrician in the last year.

Petersen, D. J., Bronstein, J., & Pass, M. A. (2002). Assessing the extent of medical home coverage among Medicaid-enrolled children. Maternal and Child Health Journal, 6(1), 59–66.

Link: https://link.springer.com/article/10.1023/A:1014320301492

NPM: 11: Medical Home
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Patient-Centered Medical Home, Continuity of Care (Caseload), PATIENT/CONSUMER, Enabling Services

Intervention Results:

• The overall proportion of children seeing any PCP increased after PCCM implementation. There was an increase from 6.7% to 9.1% in the portion of children who met the definition of having a medical home, that is, those seeing only one PCP and receiving well-child care from that physician during the year. • There was also an increase in the portion of children seeing multiple physicians and receiving well-child care from one of those physicians during the year from 11.1% to 17.9%. • Overall, 45.4% of children who were continuously enrolled had no identifiable well-child care visit after PCCM implementation, an increase from 39.9% who had no well-child care before the program. • The proportion of children with no physician visits and no well-child care remained the same at 21.2%. • The site of well-child care shifted away from health departments into physician offices after PCCM implementation. For children who saw no PCP after PCCM implementation, there was a shift away from use of a health department well-child care to well-child care in specialist offices and hospitals. Overall, there was a net increase of 20,537 well-child visits to physician providers and a net decrease of 20,860 well- child visits to health departments.