Medical homes deliver primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate and culturally effective. Children with special health care needs (CSHCN) require a wide range of support to maintain health, making medical home access particularly important. We sought to understand independent risk factors for lacking access. We analyzed Ohio, USA data from the National Survey of Children with Special Health Care Needs (2005–2006). Among CSHCN, 55.6% had medical home access. The proportion achieving each medical home component was highest for having a personal doctor/nurse and lowest for receiving coordinated care, family-centered care and referrals. Specific subsets of CSHCN were significantly and independently more likely to lack medical home access: Hispanic (AOR=3.08), moderate/high severity of difficulty (AOR=2.84), and any public insurance (AOR=1.60). Efforts to advance medical home access must give special attention to these CSHCN populations and improvements must be made to referral access, family-centered care, and care coordination.
AAP, American Academy of Pediatrics (2002) Policy Statement: The Medical Home. Pediatrics110: 184–86(reaffirmed 2008).
2.
AAP, American Academy of Pediatrics, The National Center of Medical Home Initiatives for Children with Special Needs. American Academy of Family Physicians, American College of Physicians, American Osteopathic Association (2007) Joint Principles of the Patient-Centered Medical Home. Available athttp://www.medicalhomeinfo.org/(accessed 26 August 2011).
3.
BlumbergSJWelchEM, ChowdhurySR. (2008) Design and operation of the National Survey of Children with Special Health Care Needs, 2005–2006. Vital Health Stat 1Dec (45): 1–188.
4.
FuldaKGLykensK, BaeS. (2009) Factors for accessing a medical home vary among CSHCN from different levels of socioeconomic status. Maternal and Child Health Journal13(4): 455–456.
5.
GoudieAFairbrotherG, SimpsonL. (2009) Profile of Children with Special Health Care Needs in Ohio. Ohio Family Health Survey. Available at: http://www.childhealthdata.org(Accessed 26 August 2011).
6.
HeckKEMakucDM (2000) Parental employment and health insurance coverage among school-aged children with special health care needs. American Journal of Public Health90(12): 1856–1860.
7.
HHS, US Department of Health and Human Services (2000) Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: US Government Printing Office.
HHS, US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau (2008) The National Survey of Children with Special Health Care Needs: Chartbook 2005-2006. Maryland: US Department of Health and Human Services. Available at: mchb.hrsa.gov/cshchn05/MCO/02ccr.htm(accessed 31 March 2011).
LabreeWFoetsMWeisglas-KuperusN (2010) Continuity and coordination of care during and after neonatal intensive care. Journal of Child Health Care14(3): 239–249.
13.
National Center for Health Statistics (2007) The National Survey of Children with Special Health Care Needs (NS-CSHCN) 2005-6: The Public Use Data File. Hyattsville, MD: US Department of Health and Human Services.
Ohio State Government: Ohio Revised Code (2010) General Assembly File No. 36, HB 198, § 1, Patient Centered Medical Home Education Pilot Project. Ohio. Available at: http://codes.ohio.gov/orc/185(accessed 26 August 2011).
17.
PedlowSLukeJVBlumbergSJ (2007) Multiple imputation of missing household poverty level values from the National Survey of Children with Special Health Care Needs, 2001, and the National Survey of Children’s Health, 2003. [pdf] USA. Available at: www.cdc.gov/nchas/data/slaits/mimp0103.pdf(accessed 26 August 2011).
18.
SinghGKStricklandBB, GhandourRM. (2009) Geographic disparities in access to the medical home among US CSHCN. Pediatrics124(4): S352–S360.
19.
StricklandBBMcPhersonM, WeissmanG. (2004) Access to the medical home: results of the National Survey of Children with Special Health Care Needs. Pediatrics113(5): 1485–1492.
20.
StricklandBBSinghGK, KoganMD. (2009) Access to the medical home: New Findings from the 2005-2006 national survey of children with special health care needs. Pediatrics123(6): e996–e1004.
21.
SwansonMEWallS, KiskerE. (2011) Health disparities in low-income families with infants and toddlers: Needs and challenges related to disability. Journal of Child Health Care15(1): 25–38.
22.
StricklandBBJonesJRGhandourRM. (2011) The Medical Home: Health Care Access and Impact for Children and Youth in the United States. Pediatrics127(604): 604–611.
23.
TippyKMeyerK, AronsonR. (2005) Characteristics of coordinated ongoing comprehensie care within a medical home in Maine. Maternal and Child Health Journal9(2Suppl): s13–s21.
