Enhanced community health care homes as structural interventions for hi-risk urban and rural children

A national pilot study was conducted to demonstrate the capacity of a network of cross-country pediatric primary care providers to function as “enhanced” health care homes delivering mobile, community and/or school-based nontraditional comprehensive services to undeserved children. This presentation explores the “enhanced” health care home's capacity to serve as a national model of geographically diverse structural interventions fostering comprehensive, coordinated care linkages to marginalized neighborhoods and increased access to culturally-competent, child-centered systems of care. This conceptual frame and preliminary findings suggest that structural barriers such as poverty, language isolation, and homelessness may be mitigated by coordination of care, service integration, and supported access. The potential for advancing public health goals and reducing inequities is discussed. Structural interventions operate on macro elements in the environment that facilitate or impede access to care. 100% of the network's medical directors reported that they served patients regardless of ability to pay; 100% reported that they helped identify health insurance resources for patients without resources; 94.7% provided direct 24/7 access to providers and 73.7% reported that plans of care are coordinated with educational or community organizations to address special needs. 84.2% of medical directors reported that they always or usually have medical interpreters or translators available. Almost half of these providers are providing fluoride varnishing to children without oral health care. This presentation makes the case that sufficient process data bolstering evidence of the presence of health care home core elements is requisite before conducting outcome and/or cost benefits analysis.