The Patient-Centered Medical Home, Practice Patterns, and Functional Outcomes for Children with Attention Deficit/Hyperactivity Disorder

Published in: Academic Pediatrics, v. 11, no. 6, Nov. 2011, p. 500-507

Posted on RAND.org on January 01, 2011

by Sara L Toomey, Eugenia Chan, Jessica A Ratner, Mark A. Schuster

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To determine whether children with attention deficit/hyperactivity disorder (ADHD) receive care in a patient-centered medical home (PCMH) and how that relates to their ADHD treatment and functional outcomes. METHODS: Cross-sectional analysis of the 2007 National Survey for Children's Health, a nationally representative survey of 91,642 parents. This analysis covers 5169 children with parent-reported ADHD ages 6–17. The independent variable is receiving care in a PCMH. Main outcome measures are receiving ADHD medication, mental health specialist involvement, and functional outcomes (difficulties with participation in activities, attending school, making friends; having problem behaviors; missed school days; and number of times parents contacted by school). RESULTS: Only 44% of children with ADHD received care in a PCMH. Children with ADHD receiving care in a PCMH compared with those who did not were more likely to receive medication for ADHD (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1–1.9); less likely to have mental health specialist involvement (OR, 0.6; 95% CI, 0.4–0.7); less likely to have difficulties participating in activities (OR, 0.6; 95% CI 0.4–0.8), making friends (OR, 0.6; 95% CI, 0.5–0.9), and attending school (OR, 0.4; 95% CI, 0.3−06); less likely to have problem behaviors (OR 0.6; 95% CI 0.5–0.9); had fewer missed school days (β = −1.5, 95% CI −2.4 to −0.5); and parents were contacted by school less frequently (β = −0.2, 95% CI −0.3 to −0.1). CONCLUSIONS: For children with ADHD, receiving care in a PCMH is associated with practice pattern change and better outcomes. The PCMH may represent a promising opportunity to improve quality of care and outcomes for children with ADHD

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