Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb 27;21(1):185.
doi: 10.1186/s12913-021-06192-y.

Access to after-hours primary care: a key determinant of children's medical home status

Bing Han  1 , Peggy Guey-Chi Chen  1 , Hao Yu  2
Affiliations

Access to after-hours primary care: a key determinant of children's medical home status

Bing Han et al. BMC Health Serv Res. .

Abstract

Background: The medical home (MH) model has been promoted by both the federal and state governments in the United States in recent years. To ascertain American children's MH status, many studies have relied on a large set of survey items, posing a considerable burden on their parents. We aimed to identify individual survey items or domains that best predict MH status for children and use them to develop brief markers of MH status. We also examined whether the identified items differed by status of special health care needs and by racial/ethnic group.

Method: Using the 9-year data from Medical Expenditure Panel Survey, we examined associations between children's MH status and individual survey items or domains. We randomly split the data into two halves with the first half (training sample, n = 8611) used to identify promising items, and the second half (validation sample, n = 8779) used to calculate all statistical measures. After discovering significant predictors of children's MH status, we incorporated them into several brief markers of MH status. We also conducted stratified analyses by status of special health care needs and by racial/ethnic group.

Results: Less than half (48.7%) of the 8779 study children had a MH. The accessibility domain has stronger association with children's MH status (specificity = 0.84, sensitivity = 1, Kappa = 0.83) than other domains. The top two items with the strongest association with MH status asked about after-hours primary care access, including doctors' office hours at night or on the weekend and children's difficulty accessing care after hours. Both belong to the accessibility domain and are one of several reliable markers for children's MH status. While each of the two items did not differ significantly by status of special health care needs, there were considerable disparities across racial/ethnic groups with Latino children lagging behind other children.

Conclusion: Accessibility, especially the ability to access health care after regular office hours, appears to be the major predictor of having a MH among children. The ongoing efforts to promote the MH model need to target improving accessibility of health care after regular hours for children overall and especially for Latino children.

Keywords: Accessibility; After-hours access; Child; Marker; Medical home.

PubMed Disclaimer

Conflict of interest statement

The authors have no potential conflicts of interest.

References

    1. American Academy of Pediatrics Medical Home Initiatives for Children With Special Needs Project Advisory Committee Policy statement: organizational principles to guide and define the child health care system and/or improve the health of all children. Pediatrics. 2004;113(5 Suppl):1545. - PubMed
    1. AAP Agenda for Children: Medical Home [https://www.aap.org/en-us/about-the-aap/aap-facts/AAP-Agenda-for-Childre...].
    1. Dickens MD, Green JL, Kohrt AE, Pearson HA. The medical home. Pediatrics. 1992;90(5):774.
    1. Stange KC, Nutting PA, Miller WL, Jaén CR, Crabtree BF, Flocke SA, Gill JM. Defining and measuring the patient-centered medical home. J Gen Intern Med. 2010;25(6):601–612. doi: 10.1007/s11606-010-1291-3. - DOI - PMC - PubMed
    1. Sia C, Tonniges TF, Osterhus E, Taba S. History of the medical home concept. Pediatrics. 2004;113(Supplement 4):1473–1478. - PubMed