Preventive care and medical homes among US children with heart conditions

Abstract

Within a medical home, primary care providers can identify needs, provide services, and coordinate care for children with heart conditions. Using parent-reported data from the 2016-2017 National Survey of Children's Health, we examined receipt of preventive care in the last 12 months and having a medical home (care that is accessible, continuous, comprehensive, family-centred, coordinated, compassionate, and culturally effective) among US children aged 0-17 years with and without heart conditions. Using the marginal predictions approach to multivariable logistic regression, we examined associations between presence of a heart condition and receipt of preventive care and having a medical home. Among children with heart conditions, we evaluated associations between sociodemographic and health characteristics and receipt of preventive care and having a medical home. Of the 66,971 children included, 2.2% had heart conditions. Receipt of preventive care was reported for more children with heart conditions (91.0%) than without (82.7%) (adjusted prevalence ratio = 1.09, 95% confidence interval: 1.05-1.13). Less than half of children with heart conditions (48.2%) and without (49.5%) had a medical home (adjusted prevalence ratio = 1.02, 95% confidence interval: 0.91-1.14). For children with heart conditions, preventive care was slightly more common among younger children and less common among those with family incomes 200-399% of the federal poverty level. Having a medical home was less common among younger children, non-Hispanic "other" race, and those with ≥2 other health conditions. Most children with heart conditions received preventive care, but less than half had a medical home, with disparities by age, socioeconomic status, race, and concurrent health conditions. These findings highlight opportunities to improve care for children with heart conditions.

Keywords: Heart conditions; children; medical homes; preventive care; sociodemographic.

Figure 1.

Prevalence of receiving preventive care in the past 12 months and having a medical home, by presence of heart condition, National Survey of Children’s Health, 2016–2017. aPR: adjusted prevalence ratio ^aadjusted for sex, age, insurance type, race and ethnicity, marital status, federal poverty level, education level, number of other health conditions.

Figure 2.

Prevalence of medical home components by heart condition status, National Survey of Children’s Health 2016–2017. ^aAmong all 66,971 children in analytic sample ^bAm ong 56,744 children who usual have a place to receive care ^c Among 59,566 children who had a health care visit in the past 12 months ^d Among 12,552 children who needed referrals during the past 12 months ^eAmong 37,601 children who needed coordinated care and have ≥2 services during past 12 months *chi square p-value <0.05 comparing children with heart conditions to those without