The Medical Home: Health Care Access and Impact for Children and Youth in the United States

Abstract

The medical home concept encompasses the elements of pediatric care considered essential for all children. We describe here the characteristics of children with medical homes and the relationship between presence of a medical home and selected health care outcomes by using new data from the 2007 National Survey of Children's Health (NSCH). We used a medical home measure comprising 5 components: having a usual source of care; having a personal physician or nurse; receiving all needed referrals for specialty care; receiving help as needed in coordinating health and health-related care; and receiving family-centered care. A total of 83 448 children aged 1 to 17 years had valid data for all applicable medical home components. The NSCH is a random-digit-dial population-based telephone survey. In 2007, 56.9% of US children aged 1 to 17 years received care in medical homes. Younger children were more likely to have a medical home than their older counterparts. Substantial racial/ethnic, socioeconomic, and health-related disparities were present. Children who received care in medical homes were less likely to have unmet medical and dental needs and were more likely to have annual preventive medical visits. Approximately half of the children in the United States have access to all components of a pediatric medical home. Because the medical home is increasingly promoted as the standard for provision of high-quality comprehensive health care, these findings reinforce the need to continue and expand federal, state, and community efforts to ensure that all children have access to this model of care.