Dataset Information

Association of experiences of medical home quality with health-related quality of life and school engagement among Latino children in low-income families.

ABSTRACT:

Objective

This study examines whether patient-reported indicators of a quality medical home are associated with measures of health among Latino children in low-income families.

Data sources

Data on 3,258 children ages 2-18 years are from a cross-sectional survey of parents of children affiliated with California's Healthy Kids insurance.

Study design

Medical home quality was assessed using the Parents' Perception of Primary Care and was associated with health-related quality of life (HRQOL) overall and in four domains (physical, emotional, social, and school/daycare) and four measures of school engagement.

Principal findings

A higher total medical home score was associated with a higher total Pediatric Quality of Life Inventory score and scores in four subdomains (total beta [B]=1.77, physical B=1.71, social B=1.36, emotional B=2.22, and school/daycare B=1.69, all p<0.001). It was also associated with missing fewer than three school days due to illness (odds ratio [OR]=1.12, 95 percent confidence intervals [CI]: 1.05, 1.19), excellent/above average school performance overall (OR=1.10, 95 percent CI: 1.03, 1.17) and performance in reading (OR=1.13, 95 percent CI: 1.06, 1.20) and math (OR=1.10, 95 percent CI: 1.03, 1.16).

Conclusions

Patient-reported medical home quality indicators are favorably associated with HRQOL and measures of school engagement among Latino children in low-income families.

SUBMITTER: Stevens GD

PROVIDER: S-EPMC3393027 | biostudies-literature | 2011 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Association of experiences of medical home quality with health-related quality of life and school engagement among Latino children in low-income families.

Stevens Gregory D GD Vane Christina C Cousineau Michael R MR

Health services research 20110715 6pt1

<h4>Objective</h4>This study examines whether patient-reported indicators of a quality medical home are associated with measures of health among Latino children in low-income families.<h4>Data sources</h4>Data on 3,258 children ages 2-18 years are from a cross-sectional survey of parents of children affiliated with California's Healthy Kids insurance.<h4>Study design</h4>Medical home quality was assessed using the Parents' Perception of Primary Care and was associated with health-related quality ...[more]

PMID: 21762145

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Project description:There are a number of practical and ethical issues raised in school-based health research, particularly those related to obtaining consent from parents and assent from children. One approach to developing, strengthening, and supporting appropriate consent and assent processes is through community engagement. To date, much of the literature on community engagement in biomedical research has concentrated on community- or hospital-based research, with little documentation, if any, of community engagement in school-based health research. In this paper we discuss our experiences of consent, assent and community engagement in implementing a large school-based cluster randomized trial in rural Kenya.Data collected as part of a qualitative study investigating the acceptability of the main trial, focus group discussions with field staff, observations of practice and authors' experiences are used to: 1) highlight the challenges faced in obtaining assent/consent; and 2) strategies taken to try to both protect participant rights (including to refuse and to withdraw) and ensure the success of the trial.Early meetings with national, district and local level stakeholders were important in establishing their co-operation and support for the project. Despite this support, both practical and ethical challenges were encountered during consenting and assenting procedures. Our strategy for addressing these challenges focused on improving communication and understanding of the trial, and maintaining dialogue with all the relevant stakeholders throughout the study period.A range of stakeholders within and beyond schools play a key role in school based health trials. Community entry and information dissemination strategies need careful planning from the outset, and with on-going consultation and feedback mechanisms established in order to identify and address concerns as they arise. We believe our experiences, and the ethical and practical issues and dilemmas encountered, will be of interest for others planning to conduct school-based research in Africa.National Institute of Health NCT00878007.

Project description:BACKGROUND:Integrating primary care has been proposed to reduce fragmented care delivery for patients with complex medical needs. Because of their high rates of morbidity, healthcare use, and mortality, patients with end-stage kidney disease (ESKD) may benefit from increased access to a primary care medical home. OBJECTIVE:To evaluate the effect of integrating a primary care medical home on health-related quality of life (HRQOL) for patients with ESKD receiving chronic hemodialysis. DESIGN:Before-after intervention trial with repeated measures at two Chicago dialysis centers. PARTICIPANTS:Patients receiving hemodialysis at either of the two centers. INTERVENTION:To the standard hemodialysis team (nephrologist, nurse, social worker, dietitian), we added a primary care physician, a pharmacist, a nurse coordinator, and a community health worker. The intervention took place from January 2015 through August 2016. MAIN MEASURES:Health-related quality of life, using the Kidney Disease Quality of Life (KDQOL) measures. KEY RESULTS:Of 247 eligible patients, 175 (71%) consented and participated; mean age was 54 years; 55% were men and 97% were African American or Hispanic. In regression analysis adjusted for individual visits with the medical home providers and other factors, there were significant improvements in four of five KDQOL domains: at 12 and 18 months, the Mental Component Score improved from baseline (adjusted mean 49.0) by 2.64 (p?=?0.01) and 2.96 (p?=?0.007) points, respectively. At 6 and 12 months, the Symptoms domain improved from baseline (adjusted mean?=?77.0) by 2.61 (p?=?0.02) and 2.35 points (p?=?0.05) respectively. The Kidney Disease Effects domain improved from baseline (adjusted mean?=?72.7), to 6, 12, and 18 months by 4.36 (p?=?0.003), 6.95 (p?<?0.0001), and 4.14 (p?=?0.02) points respectively. The Physical Component Score improved at 6 months only. CONCLUSIONS:Integrating primary care and enhancing care coordination in two dialysis facilities was associated with improvements in HRQOL among patients with ESKD who required chronic hemodialysis.

Dataset Information

Association of experiences of medical home quality with health-related quality of life and school engagement among Latino children in low-income families.

Objective

Data sources

Study design

Principal findings

Conclusions

Publications

Association of experiences of medical home quality with health-related quality of life and school engagement among Latino children in low-income families.

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