Quality and equity of primary care with patient-centered medical homes: results from a national survey.
Quality and equity of primary care with patient-centered medical homes: results from a national survey.
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DOI：
10.1097/mlr.0b013e318270bb0d
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发表时间：
2013-01
期刊：
影响因子：
3
通讯作者：
Ayanian JZ
中科院分区：
文献类型：
--
作者：
Aysola J;Bitton A;Zaslavsky AM;Ayanian JZ
以病人为中心的医疗之家模式已获得支持，但这种模式对护理质量和公平性的影响值得进一步评估。确定以患者为中心的医疗之家是否与儿科初级保健质量的提高和公平性相关。利用2007/2008年全国儿童健康调查（一项针对儿童（0-17岁）父母/监护人的全国代表性调查），我们使用多变量回归模型评估了以患者为中心的医疗之家与十项护理质量指标的关联，并根据人口统计和社会经济协变量进行调整。对于与医疗之家显著相关的质量指标，我们确定了这种关联是否因种族/民族而异。与没有医疗之家的儿童相比，有医疗之家的儿童在10项质量指标中有6项的校正率显著更好（所有p≤0.02），如获得发育史（校正率%（SE）：41.7（1.3）vs. 52.0（1.1），p<0.001）。对于白色和黑人儿童，拥有医疗之家与接受发育史检查的调整率更好相关，但这些组之间的差异并没有显著缩小（风险差异（SE）差异：白人与黑人0.9（4.3）; p=0.83）。我们的研究结果强调了医疗家庭模式对儿童的好处，同时突出了需要改进的领域，例如缩小差距。我们的研究结果还强调了患者体验措施在医疗之家评估中的关键作用。
The patient-centered medical home model has gained support, but the impact of this model on the quality and equity of care merits further evaluation. To determine if patient-centered medical homes are associated with improved quality and equity in pediatric primary care. Using the 2007/2008 National Survey of Children’s Health, a nationally representative survey of parents/guardians of children (age 0–17), we evaluated the association of patient-centered medical homes with ten quality of care measures using multivariable regression models, adjusting for demographic and socioeconomic covariates. For quality indicators that were significantly associated with medical homes, we determined if this association differed by race/ethnicity. Compared to children without medical homes, those withmedical homes had significantly better adjusted rates for six of ten quality measures (all p≤0.02) such as obtaining a developmental history (adjusted rates % (SE): 41.7 (1.3) vs. 52.0 (1.1), p<0.001). Having a medical home was associated with better adjusted rates of receiving a developmental history exam for both white and black children, but the disparity between these groups was not significantly narrowed (difference in risk differences (SE): 0.9 (4.3) for Whites vs. Blacks; p=0.83). Our results underscore the benefits of the medical home model for children while highlighting areas for improvement, such as narrowing disparities. Our findings also emphasize the key role of patient experience measures in the evaluation of medical homes.