The purpose of the current study is to evaluate the effectiveness of a pilot project providing a medical home to children with special health care needs (CSHCN). This study differs from previous work in that it monitors a cohort of CSHCN one year prior to and two years after participation in a medical home intervention utilizing a quasi-experimental design.
The groups being compared demonstrated descriptive differences in emergency room (ER) and preventive visits. Statistically significant differences in ER visits were achieved by the second intervention year.
The current research demonstrates that a medical home can have demonstrable effect on utilization of preventive and emergency care by CSHCN. Limitations of the current research include small sample size and lack of information on acuity and quality of life.
[Show abstract][Hide abstract] ABSTRACT: The broad objective of this dissertation research was to examine the health care system experiences of a vulnerable population: children with complex special health care needs. This dissertation consists of three related studies designed to address gaps in the current literature, with the goal of informing policy discussions surrounding children with complex needs. The first study developed a measure to identify and describe children with complex special health care needs and applied this measure to the 2005 National Survey of Children with Special Health Care Needs. Compared to children with low to moderately complex special health care needs, high complexity children present a unique diagnostic profile and a high level of unmet needs. Additionally, families with high complexity children frequently report logistical and provider level barriers to care not commonly reported among the broader special needs population. The second study, utilizing the measure of complexity developed in the first study, presents a profile of care coordination services for children with complex health care needs and presents support for the hypothesis that receiving adequate care coordination is associated with reductions in unmet needs for services. However, only 35.6% of high complexity children receive effective care coordination. For the third study, 122 parents whose children attended a pediatric home ventilator clinic (84% of the patient population) completed a survey in order to assess the themes of unmet need and care coordination among children dependent on ventilators. More than half of families reported unmet needs for care, most frequently therapeutic services and home health care. There was a low level of unmet need for preventive and specialty care. Overall, this research demonstrates that children with complex special health care needs should be the focus of independent studies and policy discussions. Future research that does not separate the heterogeneous population of children with special health care needs by complexity will fail to identify the unique barriers to care faced by this group, leading to policies that do not benefit high complexity children and their families.
[Show abstract][Hide abstract] ABSTRACT: To examine socio-demographic disparities associated with a quality medical home.
A nationally representative sample of children ages 0-17 years (n = 102,353) from the 2003 National Survey of Children's Health. Risk factors including non-white race/ethnicity, income <200% of the federal poverty level (FPL), uninsured, parent education lesser than high school, and non-English primary household language, were examined in relation to a quality medical home separately and together as a "profile" of risk. Fourteen questions were used to measure five medical home features: access, continuity, comprehensiveness, family-centered care, and coordination. Quality was defined as a value greater than median for each feature and for an overall score.
Before and after adjustment for child demographics and health status, all studied risk factors were associated with poorer quality medical home features. Uninsured [odds ratio (OR) = 0.43, 95% confidence interval (CI): 0.40-0.47] and low-income children (OR = 0.65, CI: 0.62-0.69) had among the lowest odds of a quality medical home overall and across most features, except coordination that showed an opposite trend. Summarized through risk profiles, children experiencing all five risk factors had 93% lower odds of a quality medical home overall (OR = 0.07, CI: 0.04-0.25) compared to zero risk children.
This study demonstrates large national disparities in the quality of a medical home for children. That disparities were most prevalent for the uninsured and those in or near poverty, both modifiable risk factors, suggests that reforms to increase coverage and to lift families out of poverty are essential to assuring that children have access to the full complement of appropriate health care services including a quality medical home.
Maternal and Child Health Journal 02/2009; 14(4):580-9. DOI:10.1007/s10995-009-0454-5 · 2.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to examine sociodemographic disparities in having a quality medical home among a nationally representative sample of children with asthma.
The study examined data from the 2003 National Survey of Children's Health to identify 8360 children aged 2-17 years with asthma. Risk factors including nonwhite race/ethnicity, income <200% of the federal poverty level (FPL), uninsured, parent education less than high school, and non-English language, were examined individually and as a profile of risk in relation to a quality medical home. Fourteen questions were used to measure 5 medical home features: access, continuity, comprehensiveness, family-centered care, and coordination. A poorer quality medical home was defined as < or =66 on a 100-point scale-corresponding to the feature being present less than "usually"-for each feature and for an overall score.
Before and after adjustment for demographics and asthma difficulties, most risks except less than high school parent education were related to a poorer quality medical home. Uninsured children had the highest odds of a poorer quality medical home overall (adjusted odds ratio [OR] 5.19, 95% confidence interval [CI] 3.52-7.65) and across most features, except for coordination. Children experiencing 3+ risks had 8.56 times the odds of a poorer quality medical home overall (95% CI 4.95-14.78) versus zero risks.
This study demonstrates large national disparities in a quality medical home for children with asthma. That disparities were most prevalent for the uninsured (insurance being a modifiable risk factor) suggests increasing coverage is essential to assuring that children obtain a quality medical home.
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