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.
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.