To evaluate family-reported caregiver experiences and health care utilization of patients enrolled in the Pennsylvania Medical Home Program (PA-MHP) statewide practice network and compare results to PA-MHP practices’ Medical Home Index (MHI) scores. We hypothesized families enrolled in higher-scoring patient-and-family-centered medical homes (PCMH) on completed MHIs would report decreased caregiver burden and improved health care utilization. We analyzed surveys completed by families receiving care coordination services in PA-MHP's network and each practice's mean MHI score. A total of 3221 caregivers completed surveys evaluating hours spent coordinating care/week, missed school/workdays, sick visits, and emergency department (ED) visits. A total of 222 providers from 54 participating PA-MHP practices completed the nationally recognized MHI. Family/practice demographics were collected. We developed multivariate logistic regression models assessing independent associations among family survey outcomes and corresponding practices’ MHI scores. Families enrolled in high-scoring PCMHs had decreased odds of spending >1 h/wk coordinating care (odds ratio [OR] 0.82, adjusted OR [aOR]: 0.70, 95% confidence interval [CI] 0.55–0.90), missing workdays in the past 6 months (OR 0.82, aOR: 0.72, 95% CI 0.69–0.97), and ED visits in the past 12 months (OR 0.83, aOR: 0.81, 95% CI 0.65–0.99) in comparison to families enrolled in lower-scoring PCMHs. Families enrolled in higher-scoring PCMHs did not report fewer sick visits despite fewer ED visits, indicating more appropriate health care utilization. High-scoring PCMHs had lower percentages of publicly insured and low-income children. Higher-scoring PCMHs are associated with decreased caregiver burden and improved health care utilization across diverse PA practices. Future studies should evaluate interventions uniformly improving PCMH quality and equity.

中文翻译：

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全州医疗之家计划中护理人员负担和医疗保健使用的家庭经验

旨在评估参加宾夕法尼亚州医疗家庭计划 (PA-MHP) 全州实践网络的患者的家庭报告的护理人员体验和医疗保健利用率，并将结果与​​ PA-MHP 实践的医疗家庭指数 (MHI) 分数进行比较。我们假设，参加完成 MHI 的得分较高的以患者和家庭为中心的医疗之家 (PCMH) 的家庭会报告看护者负担减轻，医疗保健利用率提高。我们分析了在 PA-MHP 网络中接受护理协调服务的家庭完成的调查以及每个机构的平均 MHI 得分。共有 3221 名护理人员完成了调查，评估每周协调护理所花费的时间、缺课/工作日、病假就诊和急诊室 (ED) 就诊。来自 54 个参与 PA-MHP 实践的总共 222 名提供者完成了国家认可的 MHI。收集家庭/诊所人口统计数据。我们开发了多元逻辑回归模型来评估家庭调查结果与相应实践的 MHI 分数之间的独立关联。参加高分 PCMH 的家庭每周花费 >1 小时协调护理的几率降低（比值比 [OR] 0.82，调整后 OR [aOR]：0.70，95% 置信区间 [CI] 0.55–0.90），缺勤与低收入家庭登记的家庭相比，过去 6 个月（OR 0.82，aOR：0.72，95% CI 0.69–0.97）以及过去 12 个月内急诊就诊（OR 0.83，aOR：0.81，95% CI 0.65–0.99） -对 PCMH 进行评分。尽管急诊就诊次数较少，但参加得分较高的 PCMH 的家庭并未报告较少的就诊次数，这表明医疗保健利用率更高。高分 PCMH 的公共保险儿童和低收入儿童比例较低。得分较高的 PCMH 与不同 PA 实践中护理人员负担的减轻和医疗保健利用率的提高有关。未来的研究应该评估统一提高 PCMH 质量和公平性的干预措施。