To evaluate the quality of care and use of the medical home in a state-funded capitated insurance plan for low-income children—the Colorado Child Health Plan (CCHP).
A retrospective cohort study using medical record review at pediatric and family practice offices in 4 geographic areas of Colorado. At each practice, CCHP-enrolled children (6 months to 6.5 years) and 2 controls were selected, 1 with Medicaid (MK) and 1 with private insurance (PI), matched by date of birth to the CCHP-enrolled child (N = 596). CCHP-enrolled children with a diagnosis of asthma, aged 3 to 18 years, and asthmatic children with MK and PI, matched by age, were also selected from each practice (N = 139).
Quality of preventive services were comparable in the 3 groups. CCHP-enrolled children made more health maintenance visits than MK-enrolled children (1.3 CCHP vs .9 MK vs 1.1 PI) and were more frequently screened for lead (8.1% CCHP vs 3.4% MK vs 1.2% PI) and anemia (5.0% CCHP vs 4.4% MK vs 2.4% PI) than children in either control group. Documented immunization rates were similar in the 3 groups, but a shift in location of immunization from public health clinics to the primary care site was seen in the CCHP group. CCHP-enrolled children made more office visits for acute care than did MK-enrolled children (4.1 CCHP vs 3.1 MK vs 3.4 PI), but a higher proportion of these visits took place at the medical home rather than the emergency department for the CCHP group (.04) as compared with the MK (.07) or PI (.06) groups. Asthmatic children in the CCHP group made more preventive office visits for maintenance therapy and more frequently used the primary care site rather than the emergency department for acute exacerbations than did children with PI (mean ratio of emergency department visits to total acute visits .04 CCHP vs .06 MK vs .19 PI).
Despite capitated reimbursement for primary care services, CCHP provided children from low-income families with preventive, acute, and chronic care services of comparable quantity and quality to those received by children with MK or PI. The program was associated with a shift of immunization location to the primary care site and increased health maintenance care for new enrollees. CCHP-enrolled children used their medical home for the majority of acute health needs and were not high utilizers of emergency department or hospital services.
Dear Sir, to evaluated the presence of asthma as a parameter of effective response in the three groups of children is a very interesting approach, but could miss some other more obvious diseases that properly reflect the improvement in the quality of the health for the low income children. I feel that by evaluating for example, the presence and number of episodies of acute respiratory infections (ARI) and acute diarrhea (AD) could produce more significant values for the group in the low income bracket.
It is well known that in populations of low income, like the existing in third world countries or children located in the poverty bracket in well developed countries, the fact of receiving primary care, yield a significant reduction in the mortality, hospitalization rate, the immunization scheme is completed, and the malnutrition is controlled. The presence of ARI and AD are detected early and yield less complications.
Therefore, I consider that this study if additional parameters were added and evaluated, could have a more broad impact, and even yield to the development of similar health care structure as the reported in Colorado in another locations worldwide.