492 - Children With Special Health Care Needs and Engagement In The Medical Home

Publication Number: 492.4251

Margo Fingeret, Columbia University Vagelos College of Physicians and Surgeons, NY, NY, United States; Melissa S. Stockwell, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Ronald Sanchez, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Laura Robbins-Milne, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Connie Kostacos, Columbia University Vagelos College of Physicians and Surgeons, Cos Cob, CT, United States; Luz Adriana Matiz, Columbia University Vagelos College of Physicians and Surgeons, NY, NY, United States

Background: Children with special health care needs (CSHCN) require more services than those without special needs. The patient-centered medical home (PCMH) is one way to provide those services. However, little is known about what factors may influence CSHCN engagement with the PCMH.

Objective: To understand factors associated with lack of engagement in care in the PCMH for CSHCN in four urban primary care practices caring for predominantly Latino, publicly insured children.

Design/Methods: A retrospective chart review between 9/2022 and 9/2024 was conducted. Patients selected were the most medically complex, defined as having four or more subspecialists or two or more life sustaining devices. The primary outcome was lack of engagement with the PCMH, defined as not having an in person or telehealth visit with a medical provider at the PCMH in the prior six months. Data were obtained for demographics, primary care provider (PCP) type (attending, trainee, inactive), zip code (to assess distance lived from PCMH), patient portal activation, social determinants of health (SDoH) (food, housing, transportation insecurity), and involvement in care of an integrated team member (community health worker (CHW), social worker (SW), care manager (CM)). Chi square analyses were conducted to identify factors associated with not being engaged in care. Factors with a p< 0.1 were included in a multivariable logistic regression model.

Results: Data from 807 CSHCN were included with 80% engaged in care. About half were male, 74% older than 6 years, and 95% insured by Medicaid. Three quarters identified as Latino, 62% spoke English, 61% had an attending as PCP, 37% had a SW, 24% had a CHW, and 21% had a CM involved (Table 1). There was no significant association between sex, insurance, distance from PCMH, and SDoH and engagement in care. Significant differences were seen by age, race/ethnicity, PCMH site, PCP type, and SW, CHW, or CM involvement (Table 2). On multivariable regression, those who were 12 years or older, had a trainee as PCP (aOR 2.09 95% CI 1.36-3.22), or spoke a language other than Spanish or English (aOR 2.96 95% CI 1.07-8.15) had greater odds of not being engaged in care, while those who had a SW (aOR 0.32 95% CI 0.21-0.51) or CM (aOR 0.30 95% CI 0.16-0.55) involved, had lower odds of not being engaged. After controlling for other variables, PCMH site, CHW involvement, and race/ethnicity were no longer significant.

Conclusion(s): Older CSHCN, those with trainees as PCP, and those speaking languages other than Spanish or English were more susceptible to disengagement from the PCMH. SW and CM support appeared protective.

Table 1
Characteristics of Study Population

Table 2
Characteristics Associated with Engagement in Care