Date of Award

5-11-2018

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Public Health

First Advisor

Dr. Daniel Crimmins

Second Advisor

Dr. Brian Barger

Third Advisor

Dr. Catherine Rice

Fourth Advisor

Dr. Shannon Self-Brown

Abstract

The dominant pediatric model of patient-centered care is the medical home (MH). According to the American Academy of Pediatrics (2017), the MH is an approach to healthcare, which places patient needs and preferences at the center of care decisions; provides accessible, comprehensive, and continuous care; and ensures patients receive necessary referrals and care coordination. This dissertation examines the MH model’s relationship to pediatric outcomes, with a particular focus on the social, emotional, behavioral, health, and educational needs of children with special health care needs.

  • Study One: The first study is a systematic review of the MH literature with special attention to the types of outcomes measured in individual studies. Eighty-two studies were reviewed, 65 of which were not captured in past reviews. Only 57.2% of outcomes were statistically significantly associated with the MH model; however, the MH model’s relationship with these outcomes appeared to be in the desired direction for 86% of the significant outcomes captured in this review.
  • Study Two: The second study investigated the role of MH in a discrete, objective, educational outcome. Using the 2011/2012 National Survey of Children’s Health, this study examined the MH’s role in public early intervention (EI) receipt among a nationally representative sample of children birth to five, finding significantly reduced odds of public EI receipt for children with a MH.
  • Study Three: Using the 2009/2010 National Survey of Children with Special Health Care Needs, the third study investigated how the MH impacts the role of condition type on six child health outcomes (preventive services receipt; unmet need for health care; ease of use of community-based services; special education receipt; unmet need for family support services; and shared decision-making). This study determined that MH-consistent care was most beneficial for children with developmental disabilities and multiple conditions, while also showing positive effects for children with physical and mental health conditions.

While the MH model’s effect on pediatric outcomes was generally positive, counterintuitive and non-significant effects were also noted. More research is needed to determine the model’s effectiveness in everyday medical care settings and to determine best practices for dissemination and implementation of the model.

Available for download on Thursday, April 30, 2020

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