Medical Homes for Children With Special Health Care Needs: Primary Care or Subspecialty Service?
Medical Homes for Children With Special Health Care Needs: Primary Care or Subspecialty Service?
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DOI：
10.1016/j.acap.2015.10.009
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发表时间：
2016-05-01
影响因子：
3.1
通讯作者：
Lail, Jennifer L.
中科院分区：
文献类型：
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作者：
Van Cleave, Jeanne;Okumura, Megumi J.;Lail, Jennifer L.
目的：了解初级保健儿科医生（pcp）对以家庭为中心的医疗之家（FCMH）是否应该为不同复杂程度的儿童提供初级或亚专科护理的看法；并研究与这些信念相关的实践特征。方法：对2012年美国儿科学会定期调查（ps79）的数据进行分析。结果一致/强烈一致：1)初级保健应为大多数有特殊保健需要的儿童的FCMH位点，2)亚专科护理是罕见或复杂疾病儿童的最佳FCMH位点。在多变量模型中，我们测试了结果与实施FCMH的实践障碍（例如，工作文化、时间、成本）和促进因素（例如，拥有护理协调员）之间的关系。结果：在572名pcp中，65%同意/强烈同意初级保健是大多数CSHCN的最佳FCMH设置，43%同意/强烈同意亚专科护理是复杂性儿童的最佳设置。成本和时间作为FCMH实施的障碍，与认为初级保健对大多数CSHCN最好的信念相反（成本：调整优势比[AOR] 2.31, 1.36-3.90；时间：AOR: 0.48, 0.29-0.81）。缺乏沟通和协调护理的技能与认为专科护理是复杂性儿童最好的FCMH相关（AOR 1.99, 1.05-3.79）。结论：相当多的少数人支持专科护理是医疗复杂性儿童FCMH的最佳位点。一些障碍与相信初级保健是大多数CSHCN的最佳FCMH有关。解决FCMH实施中的医疗复杂性可能会提高儿科医生的感知价值。
OBJECTIVE: To examine primary care pediatricians' (PCPs) beliefs about whether the family-centered medical home (FCMH) should be in primary or subspecialty care for children with different degrees of complexity; and to examine practice characteristics associated with these beliefs.METHODS: Data from the American Academy of Pediatrics Periodic Survey (PS 79) conducted in 2012 were analyzed. Outcomes were agreement/strong agreement that 1) primary care should be the FCMH locus for most children with special health care needs (CSHCN) and 2) subspecialty care is the best FCMH locus for children with rare or complex conditions. In multivariate models, we tested associations between outcomes and practice barriers (eg, work culture, time, cost) and facilitators (eg, having a care coordinator) to FCMH implementation.RESULTS: Among 572 PCPs, 65% agreed/strongly agreed primary care is the best FCMH setting for most CSHCN, and 43% agreed/strongly agreed subspecialty care is the best setting for children with complexity. Cost and time as barriers to FCMH implementation were oppositely associated with the belief that primary care was best for most CSHCN (cost: adjusted odds ratio [AOR] 2.31, 1.36-3.90; time: AOR 0.48, 0.29-0.81). Lack of skills to communicate and coordinate care was associated with the belief that specialty care was the best FCMH for children with complexity (AOR 1.99, 1.05-3.79).CONCLUSIONS: A substantial minority endorsed specialty care as the best FCMH locus for children with medical complexity. Several barriers were associated with believing primary care to be the best FCMH for most CSHCN. Addressing medical complexity in FCMH implementation may enhance perceived value by pediatricians.