Perceptions of the medical home among inner city families

Background: The American Academy of Pediatrics states that every child should have a medical home, yet little is known about the medical home perceptions of inner city families.

Design/Methods: We conducted a bilingual, cross-sectional survey of 244 families visiting a primary care (n=40) or subspecialty clinic (n=76), or a pediatric emergency department (n=128) at an academic medical center in New York City. The survey included previously validated questions on medical home domains: continuous, accessible, comprehensive, coordinated, family centered, compassionate, and culturally effective care. Questions were used to calculate mean scores for each domain. Bi- and multivariate analyses were conducted.

Results: 79% of children were Latino, 13% Black, 77% had Medicaid, and 42% had limited English proficiency (LEP). Family-centered care was most important for Black families (28%), and comprehensive care for Latinos (26%) or families with LEP (30%). Only 39% of children had a medical home. LEP, female gender, poorer health status and patient-doctor racial/ethnic discordance were associated with lacking a medical home. On multivariate analysis, families with LEP (AOR 2.24;95% CI: 1.16-4.34); children in less than excellent health (AOR 1.99;95% CI: 1.02-3.90); and those with patient-doctor discordance (AOR 2.0;95% CI: 1.03-3.93) were twice as likely to lack a medical home.

Conclusions: Cultural factors and child s health status were better predictors of having a medical home than were insurance or having a regular doctor. Cultural differences in the relative importance of medical home domains also existed and need to be considered when designing programs to foster medical homes.