Medical Home Model of Care Appears to Benefit Caregivers Health, Too

(From the May 2018 issue of Research Now)

Parents of chronically ill teens in medical homes report a higher health-related quality of life

The care teens with special health care needs receive in a medical home appears to benefit their parents’ health, a study by Nationwide Children’s Hospital researchers found.

Parents of teens with chronic conditions receiving services under the medical home model report significantly higher scores on quality of life assessments compared to parents whose teens are not.

The higher scores were associated with family-centered and coordinated care provided within the medical home, the study published in Academic Pediatrics shows. Parents suggest that these factors, in particular, reduce pressures on the family.

“A medical home has a lot of benefits for children — we know that from a lot of research — but it has additional benefits for the family as well,” says Laura Chavez, PhD, MPH, a postdoctoral fellow in the Patient-Centered Pediatric Research Program at Nationwide Children’s and lead study author.

“The medical home was associated with improved physical, emotional, social and cognitive functioning in parents,” says Deena Chisolm, PhD, program director of the Patient-Centered Pediatric Research Program and senior study author.

For this study, researchers recruited and surveyed caregivers of 488 children aged 15 to 18 who have one or more of the 16 most common health conditions reported in the National Survey of Children with Special Health Care Needs (NS-CSHCN). Conditions include allergies, asthma, emotional problems, mental retardation, seizure disorder, heart and blood problems, cerebral palsy, muscular dystrophy and cystic fibrosis.

The families surveyed live in urban and suburban areas of central Ohio and rural regions of southeastern Ohio. Investigators identified them through Nationwide Children’s Medicaid accountable care organization, Partners For Kids.

Researchers assessed the parent’s health-related quality of life (HRQOL) with the Family Impact Module questions from the Pediatric Quality of Life Inventory.

Parents also answered medical home questions in the NS-CSHCN. This survey assesses five subcomponents of a medical home: having a usual source of care, access to a personal doctor, family-centered care, effective coordination of care and getting referrals when needed.

Parents who reported their teen received care meeting the medical home criteria reported an average HRQOL score of 74.4 out of a maximum of 100. Parents who reported that their teen’s care failed to meet the criteria reported an average HRQOL score of 65.8. The scores reflect adjustments made for the influences of demographic characteristics, health literacy and teen functional limitation.

Significant differences in scores between the two groups were persistent whether assessing their physical, social, emotional and cognitive health. Among the medical home subcomponents, only family-centered care and coordinated care were significantly associated with HRQOL score.

“This study shows the value of care coordination and the value of good communications with the family,” says Dr. Chisolm, who is also an associate professor of Pediatrics at The Ohio State University colleges of Medicine and Public Health. “The spillover effect may reduce medical related costs for the whole family and may potentially make it worth the investment to expand medical home care.”  

She and Dr. Chavez suggest prospective studies evaluating the associations could build a case for further investing in the medical home model for vulnerable children and their families.

Citation: Chavez LJ, Grannis C, Dolce M, Chisolm DJ. Benefits of a medical home care reaching beyond chronically ill teens: exploring parent health-related quality of life. Academic Pediatrics. 2018 Mar 15. pii: S1876-2859(18)30081-0. doi: 10.1016/j.acap.2018.02.007. [Epub ahead of print]