{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T04:47:11Z","timestamp":1779338831295,"version":"3.51.4"},"reference-count":38,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T00:00:00Z","timestamp":1730419200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Weill Cornell Division of General Internal Medicine Primary Care","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,9,30]]},"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Receiving care at patient-centred medical homes (PCMH) is associated with reduced emergency department (ED) visits among children. Adverse social determinants of health (SDoH), such as lower socioeconomic status and household poverty, are associated with increased ED visits in children. The objective of this study is to use machine learning techniques to understand the relative importance of each PCMH component among different populations with adverse SDoH on the outcome of ED visits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods: design, setting and participants<\/jats:title>\n                    <jats:p>This study used the 2018\u20132019 pooled data from the National Survey of Children\u2019s Health (NSCH), an annual survey of parents and caregivers of US children from birth to 17 years. PCMH components were operationalised by classifying parent\/caregiver responses into five domains: care coordination (CC), having a personal doctor or nurse, having a usual source of care, family-centred care and ease of getting referrals. SDoH included five categories: (1) social and community context, (2) economic stability, (3) education access and quality, (4) healthcare access and quality and (5) neighbourhood and built environment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measure<\/jats:title>\n                    <jats:p>We used a split-improvement variable importance measure based on random forests to determine the importance of PCMH domains on ED visits overall and stratified by SDoH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, between 3% and 28% experienced one or more gaps in PCMH domains. Models show that problems with referrals (rank, 2; Gini, 83.5) and gaps in CC (rank, 3; Gini, 81.0) were the two most important domains of PCMH associated with ED visits in children. This result was consistent among black and Hispanic children and among children with lower socioeconomic status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our study findings underscore the importance of poor CC and referrals on ED visits for all children and those from disadvantaged populations. Initiatives for expanding the reach of PCMH should consider prioritising these two domains, especially in areas with significant minority populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-081533","type":"journal-article","created":{"date-parts":[[2024,11,2]],"date-time":"2024-11-02T23:06:26Z","timestamp":1730588786000},"page":"e081533","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Importance of medical home domains on emergency visits using a cross-sectional national survey of US children"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6129-6683","authenticated-orcid":false,"given":"Mangala","family":"Rajan","sequence":"first","affiliation":[{"name":"Department of Medicine, Weill Cornell Medicine, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin R","family":"Baer","sequence":"additional","affiliation":[{"name":"University of St Andrews, St Andrews, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adina","family":"Scheinfeld","sequence":"additional","affiliation":[{"name":"Princeton University, Princeton, New Jersey, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erika L","family":"Abramson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Weill Cornell Medicine, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Kern","sequence":"additional","affiliation":[{"name":"Department of Medicine, Weill Cornell Medicine, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Pinheiro","sequence":"additional","affiliation":[{"name":"Department of Medicine, Weill Cornell Medicine, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,11,2]]},"reference":[{"key":"2025121220530477000_14.11.e081533.1","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/j.acap.2019.02.006","article-title":"Trends in Visits and Costs for Mental Health Emergencies in a Pediatric Emergency Department, 2010-2016","volume":"19","author":"Hoffmann","year":"2019","journal-title":"Acad Pediatr"},{"key":"2025121220530477000_14.11.e081533.2","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.jemermed.2018.04.019","article-title":"Emergency Care for Children in the United States: Epidemiology and Trends Over Time","volume":"55","author":"Whitfill","year":"2018","journal-title":"J Emerg Med"},{"key":"2025121220530477000_14.11.e081533.3","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1001\/jamapediatrics.2022.4885","article-title":"Mental Health Revisits at US Pediatric Emergency Departments","volume":"177","author":"Cushing","year":"2023","journal-title":"JAMA Pediatr"},{"key":"2025121220530477000_14.11.e081533.4","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/j.acap.2021.01.006","article-title":"Preventing Emergency Department Visits for Children With Medical Complexity Through Ambulatory Care: A Systematic Review","volume":"21","author":"Pulcini","year":"2021","journal-title":"Acad Pediatr"},{"key":"2025121220530477000_14.11.e081533.5","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.152.10.1003"},{"key":"2025121220530477000_14.11.e081533.6","unstructured":"Prevention,O.o.D. and H. 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