Parents' preferences for enhanced access in the pediatric medical home: a discrete choice experiment.

Abstract:

IMPORTANCE:Efforts to transform primary care through the medical home model may have limited effectiveness if they do not incorporate families' preferences for different primary care services. OBJECTIVE:To assess parents' relative preferences for different categories of enhanced access services in primary care. DESIGN, SETTING, AND PARTICIPANTS:Internet-based survey that took place with a national online panel from December 8, 2011, to December 22, 2011. Participants included 820 parents of children aged 0 to 17 years. Hispanic and black non-Hispanic parents were each oversampled to 20% of the sample. The survey included a discrete choice experiment with questions that asked parents to choose between hypothetical primary care practices with different levels of enhanced access and other primary care services. MAIN OUTCOMES AND MEASURES:We estimated parents' relative preferences for different enhanced access services using travel time to the practice as a trade-off and parents' marginal willingness to travel in minutes for practices with different levels of services. RESULTS:The response rate of parents who participated in the study was 41.2%. Parents were most likely to choose primary care offices that guaranteed same-day sick visits (coefficient, 0.57 [SE, 0.05]; P < .001) followed by those with higher professional continuity (coefficient, 0.36 [SE, 0.03]; P < .001). Parents were also significantly more likely to choose practices with 24-hour telephone advice plus nonurgent email advice (0.08 [0.04]; P < .05), evening hours 4 or more times a week (0.14 [0.04]; P < .001), and at least some hours on weekends. Parents were significantly less likely to choose practices that were closed during some weekday daytime hours or had wait times longer than 4 weeks for preventive care visits. There was very little variation in preferences among parents with different sociodemographic characteristics. Parents' marginal willingness to travel was 14 minutes (95% CI, 11-16 minutes) for guaranteed same-day sick visits and 44 minutes (95% CI, 37-51 minutes) for an office with idealized levels of all services. CONCLUSIONS AND RELEVANCE:As primary care practices for children implement aspects of the medical home model, those that emphasize same-day sick care and professional continuity are more likely to meet parents' preferences for enhanced access. Practices should seek to engage families in prioritizing changes in practice services as part of medical home implementation.

journal_name

JAMA Pediatr

journal_title

JAMA pediatrics

authors

Zickafoose JS,DeCamp LR,Prosser LA

doi

10.1001/jamapediatrics.2014.3534

subject

Has Abstract

pub_date

2015-04-01 00:00:00

pages

358-64

issue

4

eissn

2168-6203

issn

2168-6211

pii

2107184

journal_volume

169

pub_type

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