OBJECTIVE:Multidisciplinary clinics (MDCs) aim to provide streamlined, coordinated care and better clinical outcomes for patients requiring access to multiple specialists with unique expertise. Despite broad endorsement in clinical guidelines, no generalizable framework exists for MDC development. METHODS:Drawing on published principles of collaborative care, pediatric-specific considerations, and the authors' collective experience, we propose a seven-step framework (EDUCATE) for establishing effective MDCs: Envision the MDC, Develop the team, Undertake the business proposal, Consolidate support, Activate operations, Team-build/educate/engage, and Expand the mission. RESULTS:The framework was implemented in a pediatric MDC for Prader-Willi syndrome, with measurable improvements in patient access, care coordination, and family experience. CONCLUSIONS:The EDUCATE framework provides a structured, replicable process for building sustainable MDCs in ambulatory care settings.
Objective: Health care delivery has undergone a shift from in-person visits to more remote consultations via telehealth. Despite the increasing adoption of telehealth for tertiary medical centers’ new patient visits, its impact on subsequent in-person health care utilization has not been widely studied. Our objective was to examine differences in health care services used by patients who established care in-person versus those who initiated care remotely via telehealth. Methods: We conducted a retrospective review of all patients who established care at one of our three main Mayo Clinic campuses through either an in-person or telemedicine visit between September 1, 2023, and September 30, 2024. We analyzed aggregate data related to downstream in-person services encompassing diagnostic studies, outpatient procedures, surgical procedures (referred to as “surgical yield”), specialist consultations, and follow-up appointments. Results: This study evaluated 252,356 new patient visits, of which 14,915 (5.9%) were performed remotely via telemedicine. Patients who established care in-person had an average of 10.47 subsequent in-person visits. Among patients who initiated care via telemedicine, 62.7% (9,351) later received in-person services, with an average of 16 in-person visits per patient. Surgical yield was higher for patients who started remotely via telehealth and then came on-site, at 29% compared to 16% for those who started with an on-site visit. States bordering the clinic locations had increased percentages of in-person visits compared to states that required patients to travel longer distances. Conclusions: Patients who established care through an initial telemedicine appointment and then came on-site had more downstream encounters and surgical procedures than those who began in-person. This may be due to the ability to efficiently coordinate multiple appointments within a condensed timeframe, optimizing the planning of on-site visits. Additionally, both patients and providers may selectively utilize telemedicine to identify individuals who would derive the greatest benefit from in-person care.
Objective: This study explored how artificial intelligence (AI) technologies support the nondiagnosing/nontreatment roles of allied health workers, examining challenges and risks AI may pose for the workforce and highlighting areas for expansion as AI use grows. Methods: We conducted 12 interviews with 14 key informants familiar with specific allied health occupations and how AI has been incorporated into their roles. Themes and gaps identified from peer-reviewed and gray literature informed our semi-structured interview guide. We used rapid content analysis to summarize findings from interviews around the following tasks: transcription, medical coding/billing, translation/interpretation, scheduling, communication, and data collection/management. We also summarized findings around ensuring AI literacy. Results: Allied health occupations (typically considered occupations other than physicians, nurses, and dentists) not directly involved in patient diagnosis and treatment have varying levels of interaction with AI. Positive descriptions of AI use in these allied health roles included situations where workforce demand exceeds supply and where AI can be deployed for some routine administrative tasks and may improve job satisfaction by allowing the workforce to focus on more complex and rewarding tasks. AI use was also described positively where it contributed to increased efficiency, for example, in facilitating communications. Because AI can produce biased or erroneous results, cautions about its applications included needing additional staff time to monitor outcomes and avoid negative impacts on patient safety and an organization’s operations. Education that contributes to AI literacy across the health workforce is considered critical for its appropriate use. Conclusions: To date, most allied health workers’ jobs with administrative/management roles have not been at risk of replacement by AI. AI’s rapidly expanding use, however, combined with the ongoing impacts of provider burnout and financial pressures on health systems, could incentivize increased interest in using AI to compensate for a downsized workforce, including many allied health occupations.
OBJECTIVE:To identify actionable steps from a Veterans Health Administration (VA) Intensive Primary Care (IPC) pilot in five VA sites that primary care teams and health care systems can take to optimize medication regimens in high-risk patients, many of whom have polypharmacy and poor medication adherence. METHODS:We conducted semi-structured, qualitative interviews between 2014 and 2018 with 27 IPC providers and 16 IPC patients. Interviews were analyzed using inductive and deductive approaches to thematic analysis. RESULTS:Patient respondents were an average of 67 years old and more likely to be male (94%), divorced (44%), Black (50%), hypertensive (88%), and have two or more comorbidities (81%). IPC patients and providers described IPC as helping to identify and/or address specific medication adherence barriers that were not adequately understood or addressed in usual primary care. IPC providers' greater understanding of adherence barriers allowed them to optimize patient medication regimens, closing the gap between care provided and patient needs. IPC program elements that enabled care improvements included interdisciplinary care teams, care team accessibility, home visits, and close provider-patient relationships. CONCLUSIONS:Primary care teams can adopt some IPC program elements to help patients optimize medication regimens, such as greater involvement of extended team members, increasing accessibility of care teams through telephone and secure messaging, utilizing home visits for assessment of patients' needs, and developing strong provider-patient relationships.
OBJECTIVE:Federally Qualified Health Centers (FQHCs) serve as critical safety net providers for over 30 million patients annually, operating with diverse payer mixes that create unique financial and operational challenges. This study examined associations between payer mix patterns and clinical quality outcomes in FQHCs, comparing relationships between 2019 and 2022 to capture COVID-19-related coverage transitions. METHODS:Using Resource Dependence Theory, we conducted a repeated cross-sectional analysis of Uniform Data System data from 1,190 FQHCs in 2019 and 1,150 FQHCs in 2022, examining eight clinical quality measures before (2019) and after (2022) the pandemic-driven coverage shifts. Multiple linear regression models with state-clustered robust standard errors assessed associations between payer mix proportions (Medicaid, Medicare, uninsured, with private insurance as reference) and quality performance, controlling for organizational characteristics. RESULTS:Results revealed complex, evolving relationships between payer mix and quality. In 2019, a 10 percentage point (pp) increase in Medicaid proportion was associated with lower performance on tobacco screening (-1.64 pp, p =.004), statin therapy (-1.43 pp, p = .014), and colorectal screening (-1.91 pp, p = .010). By 2022, tobacco screening associations reversed, with Medicaid (0.94 pp, p = .023) and uninsured (1.35 pp, p = .009) populations showing better performance than the privately insured. For outcome measures, higher proportions of Medicaid and uninsured patients were consistently associated with more patients with uncontrolled diabetes across both years, while higher Medicare proportions were associated with fewer patients with uncontrolled diabetes. Larger FQHCs showed better performance on process measures, while rural location was associated with lower cervical cancer screening rates but better hypertension control. CONCLUSIONS:These findings suggest that payer mix associations with quality are neither uniform nor stable over time, challenging assumptions about resource munificence and organizational performance in safety net settings. Policymakers should consider the dynamic nature of payer mix associations when designing payment models and quality improvement initiatives for FQHCs.
OBJECTIVES:This study aimed to evaluate the impact of a multi-layered intervention on improving rates of cardiac stress test scheduling and completion by reducing barriers to scheduling. METHODS:Using a nonrandomized mixed-methods pre-post design, we identified patients for whom a stress test was ordered in primary care but had not been scheduled within 4 weeks. The first intervention consisted of proactive outreach phone calls by a primary care patient service representative for test scheduling. The second intervention consisted of priming phone calls to patients, which served as a reminder to schedule their appointment and an invitation to participate in a brief, semi-structured interview to understand barriers to test scheduling. Changes in scheduling rates and completion rates were analyzed using hypothesis tests, and time to completion was analyzed using X-bar/S charts. RESULTS:Compared with the baseline cohort (n = 157), patients in the intervention cohort (n = 548) completed their stress tests at a significantly higher rate (66.2% [104] baseline; 81.0% [444] intervention; p = .00008). Patients in the intervention cohort similarly scheduled their tests at an improved rate (70.1% [110] baseline; 91.2% [500] intervention). Time to test completion was also significantly reduced in the intervention group (44.70 days [σ = 72.93] baseline; 33.6 days [σ = 26.67] intervention). Interviews revealed that patients had trouble scheduling their tests due to a lack of time and confusing processes. CONCLUSIONS:A multi-layered outreach intervention was successful in improving the rates of completion and scheduling for cardiac stress tests, as well as reducing time to completion. The pilot was found to be cost-effective, but may increase workload for primary care staff. Future studies should investigate ways to automate processes to reduce the burden on the system. Our study describes a potentially quality-improving intervention by introducing a new scheduling process, which is not the existing standard of care.
Background: Academic medical centers face mounting challenges in providing timely access to ambulatory care. Objective: University of California (UC), Davis Health's innovative "Access Plus" program was a pilot program designed to expand ambulatory care hours into evenings and weekends while addressing physician work-life preferences. Approach:Launched in January 2023, the program offered physicians the option to provide care during extended hours for enhanced compensation. The initiative specifically targeted new patient appointments and UC Davis Health employees and families, creating a strategic approach to enhance physician and employee support for the initiative, reducing median days to be seen while supporting workforce wellness. Outcomes: Over 18 months, 138 physicians participated, out of 800 physicians with an ambulatory practice (17.3%), and the program served 4,312 patients, including 3,236 new patients, achieving a median 21-day reduction in wait times for new patients. While the direct program was essentially cost-neutral (negative contribution margin of <1%), the initiative generated substantial downstream revenue, resulting in a total contribution margin of $13.3 million. Next Steps: The UC Davis Health experience demonstrates that academic health systems can successfully expand traditional operating hours through well-designed programs that balance physician preferences with organizational goals to meet patient needs. This approach not only improves patient access but also maintains physician acceptance and has paved the way for other health system initiatives to enhance ambulatory care delivery, leveraging physician workforce engagement.
Objective:Research suggests that community health worker (CHW) integration within clinical care teams can improve chronic disease outcomes and address health-related social needs. However, the processes by which CHWs are integrated in Federally Qualified Health Centers (FQHCs) and organizational factors enabling their success remain incompletely understood. Within the context of a national initiative sponsored by the Centers for Disease Control and Prevention, this study assessed CHW integration across three North Carolina FQHCs with distinct patient populations, management systems, and levels of prior CHW experience to identify facilitators, barriers, and CHW impact.Methods:We conducted a qualitative evaluation using inductive thematic analysis of semistructured key informant interviews with CHWs, their managers, and clinicians at each FQHC. Transcripts were analyzed using reflexive thematic analysis to identify themes and extract representative quotes.Results:Facilitators included collaboration, targeted training, management systems, prior CHW and clinician experience, and organizational support. Barriers included unclear CHW role definition, CHW capacity and community resource constraints, and inconsistent communication about integration strategies. CHWs supported care coordination, health-related social needs referrals, and chronic disease management, improving patient engagement and outcomes.Conclusions:Findings confirmed known enablers and barriers to CHW integration, including role definition, capacity constraints, resource availability, and supportive leadership. We additionally identified novel factors impacting CHW integration, including the influence of prior experience of CHWs and clinical staff, CHW leadership in workflow development, the role of peer-learning collaboratives, and the importance of inclusive communication and data practices. Integration was most successful when CHWs shaped workflows, clinicians and managers had foundational CHW understanding, and collaborative learning spaces enabled peer exchange. These findings highlight the importance of CHW-centered program design and implementation, and may enhance existing frameworks for clinical integration of CHWs in FQHCs and similar settings.
BACKGROUND:Household energy insecurity is increasingly recognized as an important social determinant of health, affecting over a third of American households. Utility shut-off protection letters from medical providers are an important but imperfect tool to address acute energy insecurity, and their use has not yet been explored in the pediatric literature. OBJECTIVE:We aimed to characterize utility shut-off protection letter requests in a pediatric primary care population and to identify potential predictors of utility letter requests. METHODS:This was a retrospective, case-control study utilizing secondary data from electronic health records and administrative data from a large, hospital-based primary care clinic located in Boston, Massachusetts. RESULTS:During 2018 and 2019, the families of 704 patients made 1,694 utility letter requests; of those, 57% made a repeat letter request. In multivariable analysis between cases ( n = 704) and controls ( n = 704), public insurance, younger age, Black race or Hispanic ethnicity, and attending a well-child visit were positively associated with utility letter requests. A negative association was found with lower medical complexity and non-English preferred language. CONCLUSIONS:Utility shut-off protection letters were requested more frequently by families with public insurance and those with Black and Hispanic children, consistent with national studies of energy insecurity. Less frequent letter requests by non-English speaking families raise concerns for inequitable access to letters, and the finding of frequent repeat requests underscores the often-chronic nature of energy insecurity. These findings highlight the need for more equitable and sustainable approaches to energy insecurity within pediatric primary care and exploration of policy interventions, such as common applications for Medicaid and energy assistance programs, to support those at high risk for energy insecurity.
OBJECTIVE:Increasing proportions of adverse maternal health outcomes occur in the 12-month postpartum period and could be addressed in outpatient settings. Our objective was to develop and test an algorithm to support a population health tool to identify high-risk prenatal patients served by federally qualified health centers (FQHCs). METHODS:We leveraged human-centered design to develop and test the population health tool and algorithm. We conducted focus groups and a literature search to identify risk criteria for the tool. To evaluate the tool, we conducted structured interviews and predictive modeling to compare the recall between the original tool and the refined algorithm. The population health tool was initially tested using electronic health record (EHR) data at six pilot FQHCs. To test the model's predictive capacity, we expanded to 18 FQHCs. Focus group participants included FQHC clinicians and staff. Data to evaluate the population health tool were queried from prenatal patients receiving care at participating FQHCs. The primary outcomes were adverse outcomes addressed in outpatient settings and health care utilization within 12 months postpartum. RESULTS:Two focus groups (N = 7) were conducted to inform the implementation. In follow-up interviews (n = 6), users highlighted the tool's utility for identifying high-risk patients. In the predictive models (N = 82,829), the adverse outcome recall increased by 16%, but the algorithm only correctly predicted 42% of adverse outcomes experienced. The postpartum visit recall increased by 45%, with the algorithm correctly predicting 96% of visits utilized. CONCLUSION:Results of this project highlight the importance of a deep understanding of EHR data capture and the involvement of clinicians when developing, testing, and evaluating interventions aimed at optimizing care for vulnerable patient populations. Future research should incorporate inpatient, outpatient, and social determinants data to develop a more comprehensive understanding of maternal health risk in the postpartum period.
Background:Individuals with substance use disorders (SUDs) have high rates of medical and mental health comorbidities, health care utilization, and costs. Improving the capacity of care management programs to meet the needs of those with SUDs could benefit Medicaid accountable care organizations, but there are few reports of strategies to do so.Program Approach:The Boston Medical Center Health System Complex Care Management (CCM) program aims to build trusting relationships with the highest-risk patients across five Massachusetts Medicaid accountable care organizations and work with those individuals to achieve their health-related goals. Given that more than half of CCM-enrolled patients have been diagnosed with a SUD, CCM has adjusted its staffing models, workforce recruitment and development, patient identification and engagement, approach to health-related social needs, and community partnerships to better meet the needs of patients with an SUD. We have developed strategies to recruit diverse staff; train them on SUDs, harm reduction, motivational interviewing, and trauma-informed care; embed staff members in inpatient and community settings; and ensure teams have access to behavioral health staff for additional support as needed. We have also built partnerships with community, governmental, and health care organizations to ensure patients receive appropriately comprehensive care despite complex social, medical, and behavioral health needs.Outcomes:Although most patients with a SUD agree to enroll in CCM when outreached, our data indicate room to improve the rates at which we reach these individuals and sustain engagement. Preliminary pre-post data showed that CCM-enrolled patients had lower rates of overdose and higher rates of engagement with outpatient care for SUDs, mental health, and medications for opioid use disorder.Conclusion:Our experience demonstrates that with appropriate training and tools, care management staff perform vital work to improve outcomes for individuals with SUDs, although more detailed research is needed to assess the effectiveness of specific intervention components.
BACKGROUND:Implementation of evidence-based practice (EBP) is associated with professionalism; EBP knowledge and implementation of EBP increases nurse's professional values and professionalism. METHODS:A pre- and post-implementation project assessed the impact of online EBP competency education and the use of EBP mentors on EBP knowledge and professionalism. RESULTS:Slight improvement in scores for knowledge about EBP competencies and professional values were demonstrated. Total competency average score improved from a mean of 2.12 pre- to 2.56 post- (p = .003). CONCLUSIONS:Online EBP education can be utilized for ambulatory care nurses where there is a lack of clinical resources to support time outside of the clinic for education and training.
Background:Despite widespread interruptions to health care in 2020, little evidence demonstrates how populations at highest risk for poor outcomes fared across a comprehensive scope of services.Methods:Among a predominantly low-income population of individuals ages 65 and older with diabetes (n = 4,187), we measured health care service use in Medicare and Medicaid claims data from 2018 to 2020. Stratified analyses included individuals with Alzheimer disease and related dementias (ADRD, n = 1,025), individuals who used Medicaid-funded home- and community-based services (HCBS, n = 264), and long-term nursing home services (n = 365).Results:Relative to 2018-2019, adjusted quarterly rates of evaluation and management visits dropped by 26% (95% confidence interval [CI]: 23%-28%) in Q2 2020 and remained 7% lower (95% CI: 4%-10%) in Q4 2020. Persistent declines occurred for inpatient discharges and emergency room visits (relative risk Q4 2020 vs. 2018-2019: 0.87 [95% CI: 0.76-0.99] and 0.77 [95% CI: 0.69-0.87], respectively). Insulin fills declined in later 2020 (relative risk Q4 2020 vs. 2018-2019: 0.87 [95% CI: 0.79-0.95]) while annual wellness visits rebounded (relative risk Q4 2020 vs. 2018-2019: 1.19 [95% CI: 1.06-1.34]). Individuals who used Medicaid-funded HCBS or long-term nursing home services before the pandemic had large declines in evaluation and management visits (relative risk Q4 2020 vs. 2018-2019: 0.80 [95% CI: 0.69-0.93] and 0.63 [95% CI: 0.43-0.94], respectively). Nursing home residents also had notable declines in insulin fills (relative risk Q4 2020 vs. 2018-2019: 0.73, 95% CI: 0.55-0.96). Individuals with ADRD had increased skilled nursing facility admissions (relative ratio Q3 2020 vs. 2018-2019 1.60, 95% CI: 1.21-2.13). Telehealth usage in 2020 did not differ based on ADRD diagnosis.Conclusions:Extended disruptions in routine care highlight opportunities to improve support for older adults with diabetes.
The focus of this quality improvement project was to implement a team-based care model with a team including three physicians and one nurse practitioner (NP). The project included implementation of a team-based care model by utilizing a standardized NP schedule template and a team-based schedule workflow with the goal to improve quality of chronic care management; increase annual wellness visits and total number of patients seen; and increase effective NP utilization in an ambulatory care setting. The team-based care model implementation was associated with a statistically significant increase in the number of annual wellness visits completed (p < .001).
ObjectiveAs the ambulatory care landscape shifts due to advances in medical technology and a rise in medically complex patients, health care systems must evolve by optimizing team-based care models and scope-of-practice utilization. This case study describes Northwell Health Physician Partners' policy-level initiative to expand the role of medical assistants (MAs) by permitting them to communicate normal laboratory results to patients.MethodsA structured, multiphase approach was used to evaluate and implement the policy change. This included a comprehensive review of clinical workflows, stakeholder engagement, assessment of patient safety implications, and alignment with regulatory and compliance standards. The initiative prioritized maintaining the integrity of the MA role while enhancing care delivery efficiency. Training, documentation protocols, and communication standards were developed to support safe execution of this expanded task.ResultsFollowing implementation, the organization observed improved care team efficiency and enhanced patient communication workflows. Clinicians reported a reduction in administrative burden, particularly in managing normal test results. MAs were successfully integrated into follow-up communication workflows, freeing licensed staff to focus on higher-acuity needs. This scope-of-practice enhancement not only empowered MAs but also fostered greater operational synergy across the care team, enabling more efficient task distribution among clinicians, registered Nurses, and MAs and improved overall workflow. This shift facilitated optimal utilization of licensed professionals within their scope of practice allowing them to fully leverage their training and expertise. No adverse events related to the expanded task were reported during the observation period.Conclusions and Action StepsExpanding MA responsibilities to include the communication of normal laboratory results demonstrates how institutional flexibility in scope-of-practice policy can strengthen team-based care in ambulatory settings. Key lessons include the importance of stakeholder consensus, standardized training, and clear documentation protocols. This case highlights a replicable approach for other health systems seeking to address workforce challenges while ensuring patient safety and satisfaction. Future steps include ongoing evaluation of patient outcomes, expanded metrics tracking, and exploration of additional opportunities to optimize support staff roles across the ambulatory enterprise.
OBJECTIVE:The rapid evolution of artificial intelligence (AI) presents opportunities and challenges for health systems, especially safety-net providers like Federally Qualified Health Centers (FQHCs). Safety-net systems may need help with structures and processes for assessing AI applications. To address this need, this article describes Moses-Weitzman Health System's (MWHS) initial steps toward establishing an AI program that defines intentional and informed AI use. APPROACH:MWHS established two AI-focused workgroups: one of senior leaders and a cross-departmental group, providing a collaborative space for exploring potential applications, creating guidelines, and discussing concerns. With limited existing templates, MWHS crafted an AI policy emphasizing transparency, privacy, and security, outlining the criteria for implementing AI tools that interact with patient data and ensuring compliance with current regulations. Current AI-related projects focus on automating routine tasks, and research interests include evidence frameworks for making decisions about adopting AI tools and evaluating ambient listening technologies. FINDINGS:Lessons learned in building our AI program are that effective implementation requires tech-savvy leadership, cross-department collaboration, and cautious differentiation between general automation and generative AI. Challenges include the need for agile budgeting, careful vendor vetting, and safe testing environments to assess AI benefits and risks responsibly. CONCLUSIONS AND ACTION STEPS:MWHS's AI program underscores a cautious but proactive approach to AI, aiming to balance innovation with operational and ethical considerations, and offers a model for other safety-net systems beginning their AI journeys.
Objective: The objective of this study was to estimate the association between an area’s competition among Federally Qualified Health Centers (FQHCs) and cancer screening rates for cervical, breast, and colorectal cancers at an FQHC. Methods: The study employed 2 secondary datasets between 2020 and 2022—the Health Resources and Services Administration’s Uniform Data System and Unmet Need Score—to conduct a multivariable regression analysis on FQHCs’ cervical, breast, and colorectal cancer screening rates in relation to the area’s FQHC competition, measured as the Herfindahl-Hirschman Index, accounting for various FQHC-level and zip code–level control variables. Results: The results indicated a significant negative association between the area’s competition among FQHCs and cervical and colorectal cancer screening rates (Coef. = −.051, P < .01 and Coef. = −0.045, P < .01, respectively). There was no significant relationship found between breast cancer screening and the area’s FQHC competition. Positive relationships were observed between screening rates, total cost per patient at an FQHC, and the number of FQHC patients. Conclusions: The study highlights the complexities of FQHC competition, showing that while competition may be associated with service improvements in other health care contexts, its impact on preventive care delivery in the FQHC setting may be more nuanced. Enhancing outreach, care coordination, and addressing resource limitations are key for FQHCs to boost cancer screening rates and improve health outcomes for vulnerable populations. Future research should explore competition’s nuanced role further and identify strategies to mitigate its potential adverse effects on care quality.
Background and Objective: The medical home is a primary care model that offers comprehensive, uninterrupted, and family-centered care to children regardless of their special health care needs. Although the overall contribution of medical home is well-studied, the differential influence of its components on health care utilization and unmet needs, particularly for children and youth with special health care needs (CYSHCN) remains insufficiently understood. This study examined the medical home component(s) that can best predict emergency and preventive visits, and unmet needs in CYSHCN. Methods: This study analyzed 2016−2022 National Survey of Children’s Health data from 64 553 caregivers of CYSHCN aged 0–17 years using the Rao–Scott Chi-square test and multivariable logistic regression. Results: Findings show that receiving care within an overall medical home was associated with lower odds of emergency visits [adjusted odds ratio (aOR): 0.77 (95% confidence interval: 0.70–0.84)] and unmet needs [aOR = 0.29 (0.24–0.34)], and higher odds of preventive dental visits [aOR = 1.40 (1.25–1.57)]. Having a usual source for sick care and receiving effective care coordination was associated with reduced odds of emergency visits (aOR = 0.74 [0.64-0.84] and aOR = 0.85 [0.77-0.95], respectively). Receiving family-centered care [aOR = 0.45 (0.38–0.54)], no problems getting needed referral [aOR = 0.58 (0.47–0.72)], and getting effective care coordination when needed [aOR = 0.32 (0.26–0.39)] were associated with lower odds of unmet needs. The odds of utilizing preventive medical and dental visits was higher with having a personal doctor or nurse [aOR = 1.42(1.12–1.80) and aOR = 1.41 (1.20–1.65), respectively] and receiving family-centered care [aOR = 1.59 (1.18–2.12) and aOR = 1.44 (1.22–1.71), respectively]. Conclusions: The study highlights the importance of considering the differential contribution of medical home components for reducing emergency visits, addressing unmet needs, and improving preventive care, providing insights to enhance health care delivery for CYSHCN.
