Evaluation of a statewide medical home program on children and young adults with asthma

Abstract

Objective: Asthma, the most common chronic condition among children, accounts for significant healthcare utilization and impact on quality of life. Care coordination in a medical home is considered standard practice, but has not been rigorously evaluated. Methods: We initiated this pilot study of children/young adults with asthma (n = 967), ages: birth to 24 years, receiving care from a subset of pediatric practices (n = 20) participating in the Pennsylvania Medical Home Initiative, Educating Practices in Community-Integrated Care (92 practices statewide). We hypothesized children and youth with asthma receiving care coordination in the context of a formal medical home program would experience favorable associations with healthcare utilization and quality of life measures. Results: A total of 9240 care coordination encounters for this cohort of children/youth occurred over 100 days. The average length of care coordination encounter was 20.7 minutes. The most common care coordination activity was referral management (21%) and the care coordinator in the practice most often contacted parent/family and specialists (75%). Children with more severe asthma had more hospitalizations and emergency department (ED) visits than children with less severe asthma. There was a significant decrease in school absences, ED visits and acute care visits for children/youth with asthma with increasing length of time in a medical home program (p < 0.05). Conclusion: Care coordination for children/youth with asthma is feasible and may yield improvements in healthcare utilization, expenditures and quality of life. Larger-scale implementation of care coordination and medical home models for children/youth with asthma and other diagnoses are warranted.

• Asthma
• care coordination
• children and youth with special healthcare needs
• young adults
• medical home
• healthcare utilization

Acknowledgements

The authors acknowledge the support and participation of the Pennsylvania Chapter of the American Academy of Pediatrics, EPIC-IC practices, children, youth and families in this work.

Declaration of interest

The authors report no financial disclosures or conflicts of interest. The authors alone are responsible for the content and writing of this article.

The authors gratefully acknowledge funding from the federal Maternal Child Health Bureau (MCHB: H02MC04133) and Pennsylvania Department of Health (SAP-4100023019) for providing support for this project and analyses. This research work was presented at the Pediatric Academic Societies Meeting in May, 2009.