Core Outcomes: Key Measures of Performance

CSHCN receive coordinated, ongoing, comprehensive care within a medical home.

Simply put, a medical home means a source of ongoing, comprehensive, coordinated, family-centered care in the child’s community. Child health care professionals and families agree that medical homes provide important and unique benefits to children and youth with special health care needs.

The medical home can and should provide preventive services, immunizations, growth and developmental assessments, appropriate screening, health care supervision, and patient and family counseling about health and psychosocial issues. The medical home also can and should ensure that children have continuity of care from visit to visit, from infancy through transition into adulthood. In addition, it must be supported to provide care coordination services so that each family and all the professionals serving them work together, as an organized team, to implement a specific care plan and to address issues as they arise.

Collaboration between the primary, specialty, and subspecialty providers to establish shared management plans in partnership with the child and family and to formulate a clear articulation of each other’s role is a key component of the medical home concept.

Equally key is the partnership between the primary care professional and the broad range of other community providers and programs serving CSHCN and their families. The medical home concept includes a responsibility for primary care professionals to become knowledgeable about all the community services and organizations families can access.

This outcome was evaluated using a series of questions from the NS-CSHCN: whether the child has a personal doctor or nurse; whether he or she has a usual source of sick and well-child care; whether the child has had problems obtaining needed referrals; whether the family is satisfied with doctors’ communication with each other and the child’s school and other systems; whether the family gets help coordinating the child’s care if needed; whether the doctor spends enough time with the child; whether the doctor listens carefully to the parent; whether the doctor is sensitive to the family’s customs; whether the doctor provides the family with enough information; whether the parent feels like a partner in the child’s care; and whether the family receives interpretation services when needed. All of these criteria were met by 47.1 percent of CSHCN.

Children whose conditions affected their functional ability usually, always, or a great deal were less likely to receive care through a medical home (31 percent, compared to 60 percent of children whose activities were never affected by their conditions). Children in higher-income families were also more likely to have medical homes: 56 percent of children with family incomes of 400 percent of poverty or more achieved this outcome, compared to 34 percent of children in poverty.

Back to Top