Abstract
The purpose of this study was to examine predictors of coordinated and comprehensive care within a medical home among children with special health care needs (CSHCN). The latest version of the National Survey of Children with Special Health Care Needs (NS-CSHCN) employed a national random-digit-dial sample whereby US households were screened, resulting in 40,242 eligible respondents. Logistic regression analyses were performed modeling the probability of coordinated, comprehensive care in a medical home based on shared decision-making and other factors. A total of 29,845 cases were selected for inclusion in the model. Of these, 17,390 cases (58.3%) met the criteria for coordinated, comprehensive care in a medical home. Access to a community-based service systems had the greatest positive impact on coordinated, comprehensive care in a medical home. Adequate insurance coverage and being White/Caucasian were also positively associated with the dependent variable. Shared decision-making was reported by 72% of respondents and had a negative, but relatively negligible impact on coordinated, comprehensive care in a medical home. Increasing age, non-traditional family structures, urban residence, and public insurance were more influential, and negatively impacted the dependent variable. Providers and their respective organizations should seek to expand and improve health and support services at the community level.
Highlights
Edited by: Saralee Glasser, Women and Children’s Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Israel
A national telephone survey screened 372,698 children living in 196,159 homes using the children with special health care needs (CSHCN) Screener–a validated instrument that identifies children who meet the federal Maternal and Child Health Bureau (MCHB) health-consequences-based special health care needs definition [21]
Those who had adequate insurance [Exp(B) = 1.45] and who were white were more likely to receive coordinated, comprehensive care in a medical home [Exp(B) = 1.18]. Those who participated in shared decision-making were slightly less likely to receive coordinated, comprehensive care in a medical home [Exp(B) = 0.338]
Summary
Increasing age, non-traditional family structures, urban residence, and public insurance were more influential, and negatively impacted the dependent variable Providers and their respective organizations should seek to expand and improve health and support services at the community level. A national agenda was set to focus efforts on providing children with special health care needs (CSHCN) and their families with a more comprehensive approach to services including a move to community-based and family-centered care [1]. This continues today, and is reflected in Health People 2020 (HP2020), as a key outcome is care for CSHCN that is coordinated and focused on the family [2]. Parents and caregivers cited access to care as one of the primary factors impeding the overall health and quality of life of their family member
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