The Medical Home Experience of Low-income Children with Non-Urgent Encounters in Acute Care Settings.

PURPOSE: Assess relationships between having a medical home and health care-seeking behavior attitudes among parents of low-income children with non-urgent encounters in acute settings (emergency, urgent care centers). METHODS: We analyzed data from 1,743 publicly insured children within non-urgent encounters. Parents completed surveys assessing medical home access and attitudes regarding health care-seeking behavior. Multivariate logistic regression analyses were conducted to investigate relationships between medical home access and attitudes. RESULTS: Forty percent of children with non-urgent acute care encounters had medical homes. Having a medical home was positively associated with always calling the doctor before going to acute care settings and preference to take a child to their doctor if the doctor's office was open evenings and weekends. CONCLUSIONS: Although having a medical home is associated with positive attitudes regarding health care-seeking behavior, it may not suffice to overcome other barriers that precipitate non-urgentencounters.

A national study of breast and colorectal cancer patients' decision-making for novel personalized medicine genomic diagnostics.

AIM: Molecular diagnostics are increasingly being used to help guide decision-making for personalized medical treatment of breast and colorectal cancer patients. The main aim of this study was to better understand and determine breast and colorectal cancer patients' decision-making strategies and the trade-offs they make in deciding about characteristics of molecular genomic diagnostics for breast and colorectal cancer. PATIENTS & METHODS: We surveyed a nationally representative sample of 300 breast and colorectal cancer patients using a previously developed web-administered instrument. Eligibility criteria included patients aged 18 years and older with either breast or colorectal cancer. We explored several attributes and attribute levels of molecular genomic diagnostics in 20 scenarios. RESULTS: Our analysis revealed that both breast and colorectal cancer patients weighted the capability of molecular genomic diagnostics to determine the probability of treatment efficacy as being of greater importance than information provided to detect adverse events. The probability of either false-positive or -negative results was ranked highly as a potential barrier by both breast and colorectal patients. However, 78.6% of breast cancer patients ranked the possibility of a 'false-negative test result leading to undertreatment' higher than the 'chance of a false positive, which may lead to overtreatment' (68%). This finding contrasted with the views of colorectal cancer patients who ranked the chance of a false positive as being of greater concern than a false negative (72.8 vs 63%). Overall, cancer patients exhibited a high willingness to accept and pay for genomic diagnostic tests, especially among breast cancer patients. Cancer patients seek a test accuracy rate of 90% or higher. Breast and colorectal cancer patients' decisions about genomic diagnostics are influenced more by the probability of being cured than by avoiding potential severe adverse events. CONCLUSION: This study provides insights into the relative weight that breast and colorectal cancer patients place on various aspects of molecular genomic diagnostics, and the trade-offs they are willing to make among attributes of such tests.