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The Way We Measure the Patient-Centered Medical Home May Be Biased against States with a High Burden of Illness

April 07, 2014

-Guest Blog by SHARE grantee Lisa Clemans-Cope, PhD, with Victoria Lynch, MA

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.
 

With the increasing attention to PCMHs under the Affordable Care Act, which contains several provisions directed at the establishment and promotion of PCMHs not just for children but for adults as well, the need to refine the standard survey-based PCMH measure for children is an increasingly important issue.

Stay tuned for an issue brief analyzing this and other issues surrounding the standard PCMH measure in greater detail.

 

[1] US Agency for Healthcare Research and Quality. Defining the PCMH. Available from: http://pcmh.ahrq.gov/page/defining-pcmh. Accessed March 5, 2014.

[2] Sia C, Tonniges TF, Osterhus E, Taba S. 2004. “History of the Medical Home Concept.” Pediatrics 113(suppl): 1473-1478.

[3] US Department of Health and Human Services. December 2010. Healthy People 2020, Maternal, Infant, and Child Health Objectives. Washington: Government Printing Office. Available from: http://www.healthypeople.gov. Accessed November 6, 2013.

 
 

About the Authors

Lisa Clemans-Cope is a Senior Research Associate and Health Economist at the Urban Institute in Washington, DC. She is the Principal Investigator on a SHARE grant titled, "Medical Homes Measures in Household Survey Data: State-Level Estimates Using Alternative Methodological Approaches."

Victoria Lynch is a Research Associate at the Health Policy Center at the Urban Institute in Washington, DC.