Parents' Preferences for Enhanced Access in the Pediatric Medical Home: A Discrete Choice Experiment
- Parents’ strongest preferences were for practices that guaranteed same-day sick visits, followed closely by those with higher continuity of care with a provider.
- Parents were also more likely to choose practices with 24-hour telephone advice plus nonurgent email advice, evening hours four or more times per week, and at least some hours on weekends.
- There was very little variation in preferences among parents with different sociodemographic characteristics.
- Parents expressed a willingness to travel longer to practices with desirable services, including an additional 14 minutes for guaranteed same-day sick visits and 44 minutes for an office with the highest levels of all services.
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 8–22, 2011. Participants included 820 parents of children ages birth to 17 years. Hispanic and black non-Hispanic parents were each oversampled to 20 percent 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 percent. Parents were most likely to choose primary care offices that guaranteed same-day sick visits (0.57 [standard error {SE}, 0.05]; P < .001) followed by those with higher professional continuity (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 [SE, 0.04]; P < .05), evening hours four or more times per week (0.14 [SE, 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 four 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 percent confidence interval [CI], 11–16 minutes) for guaranteed same-day sick visits and 44 minutes (95 percent 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. As part of medical home implementation, practices should seek to engage families in prioritizing changes in practice services.
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