Medical home experiences and health-related quality of life among children in lower income families

Purpose: The provision of a medical home for children is now a major focus of pediatric practice and policy. This study examines whether patient-reported indicators of a quality medical home are associated with measures of health related quality of life and reported school engagement among Latino children in lower-income families.

Methods: 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 program. Medical home quality was assessed using the Parents' Perception of Primary Care and was associated with health-related quality of life (measured using the Pediatric Quality of Life Inventory--PedsQL) overall and in four domains (physical, emotional, social, and school/daycare) and four measures of school engagement. We conducted multivariable linear and logistic regressions, adjusting for demographics, insurance coverage, and setting of medical care.

Results: A higher total medical home score was associated with a higher total PedsQL 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).

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