Medical Home Model's Impact on Healthcare Disparities

Introduction

Medical homes are primary care practices where a physician or nurse practitioner (NP) establishes a long-term care relationship with patients and provides patient- and family-centered, coordinated, and culturally sensitive care (AANP, n.d.; Strickland, Jones, Ghandour, Kogan, & Newacheck, 2011). The benefits include improved healthcare access, quality, and safety. A number of states have enacted statutes supporting the medical home model after research findings revealed that health disparities for racial and ethnic minorities were reduced (NCSL, 2013).

As a nurse practitioner, I am interested in how effective a medical home model would be in reducing healthcare disparities, especially for racial and ethnic minority children residing in underserved communities. Nurse practitioners have traditionally practiced in underserved communities and will continue to do so; therefore, any strategy that could improve the quality of care with little or no additional cost would be of great interest to both me and my patients. To better understand how a medical home model can reduce health disparities, this essay reviews the findings of recent research studies on this topic.

The Medical Home Model and Minority Children

Toomey and colleagues (2013) began by discussing the importance of care coordination for improving healthcare access and quality, lowering costs, and increasing provider satisfaction. This justified their investigation of a possible causal relationship between a child's racial identity and experiencing an unmet need for care coordination. The other independent variables they examined included socioeconomic status, personal provider, and family-centered care, with the latter two variables having been empirically associated with better care quality. They used the 2007 National Survey of Children's Health data to answer their questions, which included information from parents of 91,642 children residing in all 50 states and the District of Columbia.

The prevalence of unmet care coordination need was 27, 38, and 40 percent for White, Black, and Latino children, respectively. Other predictors of unmet need were single-parent households, low income, non-English-speaking households, public insurance, no insurance, and the absence of a personal healthcare provider. In addition, children with special health care needs (CSHCNs) were more than twice as likely to have experienced an unmet need for care coordination compared to other children. Personal providers improved the chances of a minority child having access to coordinated care, but the level of health disparity was not significantly changed. In contrast, minority children with access to family-centered care were significantly less likely to experience an unmet need for coordinated care. These findings suggest that the family-centered component of medical homes can help reduce racial disparities in access to coordinated care.

Bennett and colleagues (2012) also analyzed the 2007 National Survey of Children's Health data and discovered that racial minority status, lower parental educational achievement, older age of the child, male gender, more severe health conditions, and increased functional limitations were inversely and significantly associated with CSHCNs using a medical home for their primary care needs. The magnitude of the racial identity effect was modest, however, since access to a medical home conferred only a 20 percent reduction in health disparity due to race. A medical home therefore cannot address the remaining 60 percent difference in unmet needs experienced by CSHCNs of African American descent compared to White children.