Healthy Home Environment, Low-Income Children, and Patient-Centered Medical Home

Theoretical Background and research questions/hypothesis: 

The Patient-Centered Medical Home (PCMH) is an innovative primary care delivery system that sets high standards for quality of healthcare practices. Despite the nation-wide movement to implement PCMH, we are still seeing large variation in the quality of health service provision for children. Many studies have showed that demographic characteristics and availability of providers significantly influence the healthcare quality received. However, few studies have focused on the home environment, which may act as a proxy for child-rearing behaviors that may be important in predicting the medical care children receive. Therefore, this study examines whether home environment predicts the likelihood of receiving high quality healthcare, as measured by the PCMH criteria.

Methods: 

We used the 2011-2012 National Survey of Children’s Health (n= 20,801) to examine the association between home environment and quality healthcare and how it changes in settings with sufficient supply of PCMH providers. We used ordered logistic regression for both analyses.

Results: 

Children living in the healthiest home environments were 20% more likely to receive high quality of healthcare (p=0.014) compared to those in poor home environments, and in states with higher PCMH presence, children in healthy homes had 68% better chance to enter higher quality level than the those in poor quality homes (p=0.008).

Conclusions: 

This suggests that caregivers who create a healthier home environment are more likely to choose higher quality of healthcare providers, especially when there are sufficient healthcare resources in the region. Our results also suggest that previous studies that demonstrated a significant positive impact of PCMH on healthcare outcomes may be subject to selection bias and may, therefore, overestimate the influence of PCMH practices to improve care.

Implications for research and/or practice:  Future studies should control for home environment in order to accurately identify the net effects of PCMH.