Patient-Centered Medical Home Model: Do School-Based Health Centers Fit the Model?

Abstract

School-based health centers (SBHCs) are an important component of health care reform. The SBHC model of care offers accessible, continuous, comprehensive, family-centered, coordinated, and compassionate care to infants, children, and adolescents. These same elements comprise the patient-centered medical home (PCMH) model of care being promoted by the Affordable Care Act with the hope of lowering health care costs by rewarding clinicians for primary care services. PCMH survey tools have been developed to help payers determine whether a clinician/site serves as a PCMH. Our concern is that current survey tools will be unable to capture how a SBHC may provide a medical home and therefore be denied needed funding. This article describes how SBHCs might meet the requirements of one PCMH tool. SBHC stakeholders need to advocate for the creation or modification of existing survey tools that allow the unique characteristics of SBHCs to qualify as PCMHs.

Keywords

advanced nursing practice children’s health federal legislation public health payment for nursing services state leg

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References

Allison

M. A.

Crane

L. A.

Beaty

B. L.

Davidson

A. J.

Melinkovich

Kempe

(2007) School-based health centers: Improving access and quality of care for low-income adolescents. Pediatrics 120(4): e887–e894. doi:10.1542/peds.2006-2314.

American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, & American Osteopathic Association. (2007). Joint principles of the patient-centered medical home. Retrieved from http://www.acponline.org/advocacy/where_we_stand/medical_home/approve_jp.pdf.

American Academy of Pediatrics (2002) The medical home. Pediatrics 110: 184–186.

American Psychological Association. (2012). Facing the school dropout dilemma. Retrieved from http://www.apa.org/pi/families/resources/school-dropout-prevention.pdf.

Booker

J. M.

Schluter

J. A.

Carrillo

McGrath

(2011) Quality improvement initiative in school-based health centers across New Mexico. Journal of School Health 81(1): 42–48.

Brindis

C. D.

Klein

Schlitt

Santelli

Juszczak

Nystrom

R. J.

(2003) School-based health centers: Accessibility and accountability. Journal of Adolescent Health 32(6): 98–107. doi:10.1016/S1054-139X(03)00069-7.

Burton, R. A., Devers, K. J., & Berenson, R. A. (2012). Patient-centered medical home recognition tools: A comparison of ten surveys’ content and operational details. The Urban Institute, Health Policy Center, pp. 1–43. Retrieved from http://www.urban.org/UploadedPDF/412338-patient-centered-medical-home-rec-tools.pdf.

Centers for Disease Control and Prevention. (2012). National vital statistics reports births: Preliminary data for 2011. Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_05.pdf.

Centers for Disease Control and Prevention. (2013). Sexually transmitted disease surveillance 2012. Atlanta, GA: U.S. Department of Health and Human Services. Retrieved from http://www.cdc.gov/std/stats12/Surv2012.pdf.

10.

Chapman

S. A.

Wides

C. D.

Spetz

(2010) Payment regulations for advanced practice nurses: Implications for primary care. Policy, Politics, & Nursing Practice 11(2): 89–98. doi:10.1177/1527154410382458.

11.

Clarke

R. M. A.

Tseng

C. H.

Brook

R. H.

Brown

A. F.

(2012) Tool used to assess how well community health centers function as medical homes may be flawed. Health Affairs 31(3): 627–635. doi:10.1377/hlthaff.2011.0908.

12.

Clayton

Chin

Blackburn

Echeverria

(2010) Different setting, different care: Integrating prevention and clinical care in school-based health centers. American Journal of Public Health 100(9): 1592–1596. doi:10.2105/AJPH.2009.186668.

13.

Fields

Leshen

Patel

(2010) Driving quality gains and cost savings through adoption of medical homes. Health Affairs 29(5): 819–826. doi:10.1377/hlthaff.2010.0009.

14.

Finkelhor

Ormrod

Turner

Hamby

S. L.

(2005) The victimization of children and youth: A comprehensive, national survey. Child Maltreatment 10(1): 5–25. doi:10.1177/1077559504271287.

15.

Guo

J. J.

Wade

T. J.

Keller

K. N.

(2008) Impact of school-based health centers on students with mental health problems. Public Health Reports 123: 768–780.

16.

Holmboe

E. S.

Arnold

G. K.

Weng

Lipner

(2010) Current yardsticks may be inadequate for measuring quality improvements from the medical home. Health Affairs 29(5): 859–866. doi:10.1377/hlthaff.2009.0919.

17.

Husky

M. M.

Olfson

J.-P.

Nock

M. K.

Swanson

S. A.

Merikangas

K. R.

(2012) Twelve-month suicidal symptoms and use of services among adolescents: Results from the National Comorbidity Survey. Psychiatric Services 63(10): 989doi:10.1176/appi.ps.201200058.

18.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Summary. Retrieved from http://www.iom.edu/∼/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf.

19.

Johnston

L. D.

O’Malley

P. M.

Bachman

J. G.

Schulenberg

J. E.

(2011) Monitoring the future national results on adolescent drug use: Overview of key findings, 2010, Ann Arbor, MI: Institute for Social Research, the University of Michigan.

20.

Juszczak

Melinkovich

Kaplan

(2003) Use of health and mental health services by adolescents across multiple delivery sites. Journal of Adolescent Health 32(6): 108–118. doi:10.1016/S1054-139X(03)00073-9.

21.

Keeton

Soleimanpour

Brindis

C. D.

(2012) School-based health centers in an era of health care reform: Building on history. Current Problems in Pediatric and Adolescent Health Care 42(6): 132–156. doi:10.1016/j.cppeds.2012.03.002.

22.

Kerns

S. E. U.

(2011) Adolescent use of school-based health centers and high school dropout. Archives of Pediatrics & Adolescent Medicine 165(7): 617doi:10.1001/archpediatrics.2011.10.

23.

Ma, J., Wang, Y., & Stafford, R. S. (2005). U.S. adolescents receive suboptimal preventive counseling during ambulatory care. Journal of Adolescent Health, 36, 441.e1–441.e7.

24.

Merikangas

K. R.

Burstein

Swanson

S. A.

Avenevoli

Cui

Benjet

Georgiades

Swendsen

(2010) Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of Applied Analysis and Computation 49(10): 980–989. doi:10.1016/j.jaac.2010.05.017.

25.

Merikangas

K. R.

Burstein

Swendsen

Avenevoli

Case

Georgiades

Heaton

Swanson

Olfson

(2011) Service utilization for lifetime mental disorders in U.S. adolescents: Results of the National Comorbidity Survey–Adolescent Supplement (NCS-A). Journal of Applied Analysis and Computation 50(1): 32–45. doi:10.1016/j.jaac.2010.10.006.

26.

National Assembly on School-Based Health Care. (2010). School-based health centers: National Census School Year 2007–2008. Retrieved from http://ww2.nasbhc.org/NASBHCCensusReport07-08.pdf.

27.

National Assembly on School-Based Health Care. (2011). Letter to house committee on energy and commerce and house subcommittee on health (pp. 1–11). NASBHC. Retrieved from http://www.nasbhc.org/atf/cf/%7Bcd9949f2-2761-42fb-bc7a-cee165c701d9%7D/OPPOSE%20HR1214.PDF.

28.

National Assembly on School-Based Health Care. (2012). SBHC operation grants. NASBHC. Retrieved from http://www.sbh4all.org/site/c.ckLQKbOVLkK6E/b.7697107/apps/s/content.asp?ct=11666831.

29.

National Committee for Quality Assurance. (2011a). Standards and guidelines for NCQA’s patient-centered medical home (PCMH) 2011 (pp. 1–34). NCQA.

30.

National Committee for Quality Assurance. (2011b). NCQA’s patient-centered medical home (PCMH) 2011 standards (pp. 1–53). NCQA. Retrieved from http://www.iafp.com/pcmh/ncqa2011.pdf.

31.

National Committee for Quality Assurance. (2011c). NCQA’s patient-centered medical home 2011 frequently asked questions for pediatric practices (pp. 1–11). NCQA. Retrieved from http://www.ncqa.org/portals/0/Programs/Recognition/PCMH_2011_Pediatric_FAQs_FINAL.pdf.

32.

Ogden

C. L.

(2012) Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. JAMA: The Journal of the American Medical Association 307(5): 483doi:10.1001/jama.2012.40.

33.

Patient Protection and Affordable Care Act of 2010, Pub. L. No. 111–148, §2702, 124 Stat. 119 (2010).

34.

Pawlson, L. G., Bagley, B., Barr, M., Sevilla, X., Torda, P., & Scholle, S. (2009). Patient-centered medical home: From vision to reality. Retrieved from http://www.dhcs.ca.gov/provgovpart/Documents/PCMH_Vision_to_Reality.pdf.

35.

Rittenhouse

D. R.

Casalino

L. P.

Gillies

R. R.

Shortell

S. M.

Lau

(2008) Measuring the medical home infrastructure in large medical groups. Health Affairs 27(5): 1246–1258. doi:10.1377/hlthaff.27.5.1246.

36.

Rittenhouse

D. R.

Shortell

S. M.

(2009) The patient-centered medical home: Will it stand the test of health reform? JAMA: the Journal of the American Medical Association 301(19): 2038–2040.

37.

Santelli

Kouzis

Newcomer

(1996) Student attitudes toward school-based health centers. Journal of Adolescent Health 18: 349–356.

38.

Schlitt

J. J.

Juszczak

L. J.

Eichner

N. H.

(2008) Current status of state policies that support school-based health centers. Public Health Reports 123: 731–738.

39.

Schram

A. P.

(2010) Medical home and the nurse practitioner: A policy analysis. The Journal for Nurse Practitioners 6: 132–139.

40.

Sia

Tonniges

T. F.

Osterhus

Taba

(2004) History of the medical home concept. Pediatrics 113: 1473–1478.

41.

Soleimanpour

Geierstanger

S. P.

Kaller

McCarter

Brindis

C. D.

(2010) The role of school health centers in health care access and client outcomes. American Journal of Public Health 100(9): 1597–1603. doi:10.2105/AJPH.2009.186833.

42.

Takach

(2011) Reinventing Medicaid: State innovations to qualify and pay for patient-centered medical homes show promising results. Health Affairs 30(7): 1325–1334.

43.

The Society for Adolescent Health and Medicine (2013) Promoting equity and reducing health disparities among racially/ethnically diverse adolescents: A position paper of The Society for Adolescent Health and Medicine. Journal of Adolescent Health 52: 804–807.

44.

Tijerino, A. & Ginn, M. S. (2012). Hispanic heritage foundation. Retrieved from http://www.hispanicheritage.org/images/press/HHF%20White%20Paper.pdf.

45.

Wade, T. J., & Guo, J. J. (2010). Linking improvements in health-related quality of life to reductions in Medicaid costs among students who use school-based health centers. American Journal of Public Health, 100(9), 1611–1616.

46.

Wade

T. J.

Mansour

M. E.

Guo

J. J.

Huentelman

Line

Keller

K. N.

(2008) Access and utilization patterns of school-based health centers at urban and rural elementary and middle schools. Public Health Reports 123: 739–750.

47.

Walker

S. C.

Kerns

S. E. U.

Lyon

A. R.

Bruns

E. J.

Cosgrove

T. J.

(2010) Impact of school-based health center use on academic outcomes. Journal of Adolescent Health 46(3): 251–257. doi:10.1016/j.jadohealth.2009.07.002.

48.

Weist

M. D.

Goldstein

Morris

Bryant

(2003) Integrating expanded school mental health programs and school-based health centers. Psychology in the Schools 40(3): 297–308. doi:10.1002/pits.10089.

49.

Wong, W., Anderson, K. M., Dankwa-Mullan, I., Simon, M. A., & Vega, W. A. (2012). The patient-centered medical home: A path toward health equity? [Discussion Paper]. Washington, DC: Institute of Medicine. Retrieved from http://iom.edu/Global/Perspectives/2012/PatientCenteredMedicalHome.aspx.

50.

Zickafoose

J. S.

Clark

S. J.

Sakshaug

J. W.

Chen

L. M.

Hollingsworth

J. M.

(2013) Readiness of primary care practices for medical home certification. Pediatrics 131: 1–10. doi:10.1542/peds.2012-2029.