Preventive care and Medical homes among children with heart conditions, National Survey on Children's Health 2016-2017 Open Access

Broughton, Amber (Spring 2019)

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Based on parent-reported data, an estimated 900,000 (1.3%) U.S. children currently have a congenital or acquired heart condition. Preventive care and medical homes play a critical role in the care of children with heart conditions. Thus, the purpose of this study was to estimate the prevalence of receipt of preventive care in the last 12 months and medical homes, and examine associated socioeconomic and demographic factors among U.S. children with heart conditions, both congenital and acquired. We analyzed population-based, parent-reported data from the 2016-2017 National Survey of Children’s Health on 66,971 US children ages 0-17 years. We used chi square tests and the predicted marginals approach to multivariable logistic regression to generate adjusted prevalence ratios (aPRs) to assess whether having a heart condition was associated with receipt of preventive care and having a medical home. Among children with heart conditions, we also used the predicted marginal approach to multivariable logistic regression to examine characteristics associated with preventive care and medical homes. Among children with heart conditions (n=1,563), compared to those without (n=65,408), respectively, 91.0% and 82.6% received preventive care in the last 12 months [aPR=1.09 (1.05-1.14)] and 48.2% and 49.5% have a medical home [aPR=1.03 (0.92-1.15)]. After adjusting for other variables, children 0-5 years old (aPR: 1.09, 95% CI: (1.01-1.18)) and 6-11 years old (aPR: 1.08, 95% CI: (1.01-1.16)) were more likely than children 12-17 years to have received preventive care. Children with family incomes between 200%-399% FPL (aPR= 0.92, 95% CI:(0.85-0.98)) were less likely than children with family incomes ≥400% FPL to have received preventive care. Children with heart conditions categorized as “other” race [aPR=0.64, 95% CI: (0.42-0.97)], compared to non-Hispanic white children, and those with ≥ 2 other health conditions [aPR=0.58 , 95% CI: (0.43-0.77)], compared to none, were less likely to have a medical home. These results can guide ways to increase care of children with heart conditions within a medical home and serve as a baseline to assess future changes in prevalence of preventive care and medical homes as recommendations within the AAP’s policy statement are implemented.


Table of Contents

Table of Contents

Chapter 1: Introduction 9

Problem Definition. 9

Congenital Heart Defects. 9

Acquired heart conditions 10

Preventive care. 10

Medical homes. 11

Justification and Goals of Research. 13

Theoretical framework. 13

Study Objectives .18

Research Questions .18

Chapter 2: Literature Review 20

Brief Introduction of the literature. 20

Congenital Heart Defects 21

Acquired Heart Conditions. 23

Preventive Care. 24

Preventive care among US children with heart conditions 24

Preventive care among US children living with other chronic diseases 25

Medical Homes. 26

Medical homes among U.S. children with heart conditions. 28

Medical homes among U.S. children living with other chronic diseases. 30

Social Determinants of Health Theory. 32

Health Care Access. 33

Education. 33

Economic Stability. 34

Chapter 3: Student Contribution 36

Chapter 4: Manuscript 37

Introduction. 37

Methods 38

Results 41

Discussion. 44

Conclusion. 47

Chapter 5: Public Health Implications 56

Public Health Implications 56

References. 60

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