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Relationship-focused vs. Structural Activities in Medical Home Measurement in Pediatrics
Journal article   Peer reviewed

Relationship-focused vs. Structural Activities in Medical Home Measurement in Pediatrics

Christopher J Stille, Jean L Raphael, Adam C Carle, David M Keller, Renee M Turchi, Colleen A Kraft, Marie Y Mann and Dana Bright
Maternal and child health journal, v 22(11), pp 1580-1588
Nov 2018
DOI: https://doi.org/10.1007/s10995-018-2552-8
PMID: 29926246
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Adult Female Humans Male Middle Aged Patient Care Team - organization & administration Patient-Centered Care - organization & administration Pediatricians - organization & administration Pediatricians - psychology Primary Health Care - organization & administration
Objectives The Family-Centered Medical Home (FCMH) has become a model of effective and efficient primary care. However, efforts to measure the FCMH may ignore its complexity. We sought to determine whether U.S. primary care pediatricians view structure-focused and relationship-focused practice activities of the FCMH as distinct constructs and how these constructs are associated with practice functions. Methods We analyzed data from the 2012 American Academy of Pediatrics Periodic Survey of Fellows #79 (n = 572) addressing opinions and practice activities related to the FCMH. Through a modified Delphi expert process, we selected items believed to be primarily structure-focused and items that were relationship-focused. Confirmatory factor analysis was used to test whether these constructs were distinct. Separate structural equation models assessed whether structure-focused and relationship-focused activities predicted three broader survey items: (1) interest in FCMH; (2) application for FCMH recognition; and (3) whether a team meets to discuss FCMH improvements. Results The initial two-factor model did not fit well, but improved with movement of two items from the structure to the relationship-focused group. The two factors correlated at r = 0.70. Respondents with increased relationship-focused activities had statistically higher odds of having medium/high interest in FCMH, and having a team meet to discuss FCMH improvements. Respondents with increased structure-focused activities also had higher odds of having team meetings to discuss FCMH improvements, but lower odds of applying for FCMH recognition. Conclusions for Practice The FCMH is multi-dimensional, with relationship- and structure-focused activities differentially linked to pediatrician reports of broader FCMH functions.

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Public, Environmental & Occupational Health
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