The Patient-Centered Medical Home, Practice Patterns, and Functional Outcomes for Children with Attention Deficit/Hyperactivity Disorder
The Patient-Centered Medical Home, Practice Patterns, and Functional Outcomes for Children with Attention Deficit/Hyperactivity Disorder
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DOI：
10.1016/j.acap.2011.08.010
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发表时间：
2011-11-01
影响因子：
3.1
通讯作者：
Schuster, Mark A.
中科院分区：
文献类型：
--
作者：
Toomey, Sara L.;Chan, Eugenia;Schuster, Mark A.
目的：为了确定是否有注意力缺陷/多动障碍（ADHD）的儿童接受以患者为中心的医疗之家（PCMH）的照顾，以及如何涉及到他们的ADHD治疗和功能outcomes.METHODS：2007年全国儿童健康调查，全国代表性的调查91,642家长的横断面分析。这项分析涵盖了5169名6-17岁患有父母报告的ADHD的儿童。自变量是在PCMH接受护理。主要结果指标是接受ADHD药物治疗，心理健康专家的参与，和功能结果（参与活动，上学，交朋友的困难;有问题的行为;错过上学的日子;和父母联系学校的次数）。在PCMH接受治疗的ADHD儿童与没有接受治疗的儿童相比，更有可能接受ADHD药物治疗。（比值比[1.4; 95%置信区间[CI]，1.1-1.9）;不太可能有心理健康专家参与（OR，0.6; 95%CI，0.4-0.7）;参加活动遇到困难的可能性较小（OR，0.6; 95% CI 0.4-0.8），交朋友（OR，0.6; 95% CI，0.5-0.9），和上学（OR，0.4; 95%CI，0.3-06）;不太可能出现问题行为（OR 0.6; 95% CI 0.5-0.9）;缺课天数较少（β =-1.5，95%CI-2.4至-0.5）;学校联系家长的频率较低（β =-0.2，95%CI-0.3 to -0.1）.结论：对于ADHD儿童，在PCMH接受护理与实践模式的改变和更好的结果相关。PCMH可能代表了一个很有希望的机会，以提高ADHD儿童的护理质量和结果。
OBJECTIVE: To determine whether children with attention deficit/hyperactivity disorder (ADHD) receive care in a patient-centered medical home (PCMH) and how that relates to their ADHD treatment and functional outcomes.METHODS: Cross-sectional analysis of the 2007 National Survey for Children's Health, a nationally representative survey of 91,642 parents. This analysis covers 5169 children with parent-reported ADHD ages 6-17. The independent variable is receiving care in a PCMH. Main outcome measures are receiving ADHD medication, mental health specialist involvement, and functional outcomes (difficulties with participation in activities, attending school, making friends; having problem behaviors; missed school days; and number of times parents contacted by school).RESULTS: Only 44% of children with ADHD received care in a PCMH. Children with ADHD receiving care in a PCMH compared with those who did not were more likely to receive medication for ADHD (odds ratio [On 1.4; 95% confidence interval [CI], 1.1-1.9); less likely to have mental health specialist involvement (OR, 0.6; 95% CI, 0.4-0.7); less likely to have difficulties participating in activities (OR, 0.6; 95% CI 0.4-0.8), making friends (OR, 0.6; 95% CI, 0.5-0.9), and attending school (OR, 0.4; 95% CI, 0.3-06); less likely to have problem behaviors (OR 0.6; 95% CI 0.5-0.9); had fewer missed school days (beta = -1.5, 95% CI -2.4 to -0.5); and parents were contacted by school less frequently (beta = -0.2, 95% CI -0.3 to -0.1).CONCLUSIONS: For children with ADHD, receiving care in a PCMH is associated with practice pattern change and better outcomes. The PCMH may represent a promising opportunity to improve quality of care and outcomes for children with ADHD.