Children with special health care needs (CSHCN) often require specialized care from multiple health care providers in addition to preventive and primary care services (Van Dyck et al., 2004). Lack of coordination among providers and inadequate access to a "medical home" can place these children at high risk for adverse outcomes, including duplication of services, failure to receive necessary care, and increased use of emergency and inpatient services (Strickland et al., 2009). Although any practice that provides health care to children could serve as the child's medical home, in most cases it will be the primary care practices that play this role.
Preliminary evidence suggests that pediatric practices that have implemented components of a medical home provide better care to their patients compared with those without such components, at least on some dimensions. For example, Homer et al. (2008) reviewed over 30 studies of medical homes for CSHCN with varying study designs from randomized controlled trials to cross-sectional analyses; the authors found evidence that medical homes were consistently positively associated with timeliness of care, although evidence was mixed for other outcomes, such as effectiveness, efficiency, family centeredness, and functional status. In cross-sectional analyses, Cooley et al. (2009) reported that some medical home characteristics, such as strong chronic condition management, were correlated with fewer hospitalizations and emergency department (ED) visits. Various multi-payer initiatives now provide incentives for practices to become medical homes (Takach, 2011). Since 2008, the National Committee for Quality Assurance (NCQA) has recognized practices and providers who meet its standards for patient-centered medical homes (PCMHs) and submit required documentation and fees (NCQA, 2012). Although it is not the only PCMH program available, NCQA's initiative has a high profile and is widely used in many multi-payer initiatives (Takach, 2011). The number of NCQA-certified practices and providers increased from 28 and 214, respectively, in 2008 to 1,506 and 7,676, respectively, by the end of 2010 (NCQA 2011 PCMH Overview).
While the rapid growth in NCQA-recognition reflects a promising trend in pediatric care, there has been no direct test of the relationship between NCQA-recognition and patterns of health service use for Medicaid-enrolled CSHCN. We hypothesized that compared with CSHCN treated by providers who have not received NCQA medical home recognition, CSHCN treated by NCQA-recognized providers will have more well-child visits, fewer ED visits and hospitalizations as well as more comprehensive care coordination, measured by follow-up after ED visits and hospitalizations.