April 7, 2014: The Patient Centered Medical Home (PCMH) is a model of primary care that originated in the field of pediatrics and focuses on delivering comprehensive, patient-centered, coordinated, accessible, quality, and safe care.[1]  For the past several decades it has been a national goal to ensure that children have patient centered care within a medical home, and there has been widespread effort to develop consensus on how to define and measure the PCMH concept.[2] [3] Great progress has been made but due to the way missing information is treated, there are validity issues with the way the current survey-based standard measure estimates the prevalence of children with a medical home.

 

The National Survey of Children’s Health (NSCH) and the National Survey of Children with Special Health Care Needs (NS-CSHCN) are national surveys often used to estimate the prevalence of children with a medical home.  Our analysis finds that the treatment of missing data in the construction of the medical home measure in these surveys is part of the reason the surveys show that children with special health care needs (CSHCN) are less likely to have a medical home compared to well children. This finding has implications for state policymakers, because it demonstrates that the NSCH and the NS-CSHCN have an inherent bias against states with a higher burden of illness.

 

 

---