Disparities in Self-reported Access to Patient-centered Medical Home Care for Children With Special Health Care Needs
Disparities in Self-reported Access to Patient-centered Medical Home Care for Children With Special Health Care Needs
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DOI：
10.1097/mlr.0000000000000978
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发表时间：
2018-10-01
期刊：
影响因子：
3
通讯作者：
Thomas, Kathleen C.
中科院分区：
文献类型：
--
作者：
Jolles, Monica Perez;Thomas, Kathleen C.
背景：改变初级保健的努力已经进行了十多年。然而，我们对在全国范围内推广这种护理模式的进展缺乏了解，也不了解以患者为中心的医疗之家(PCMH)是否造福了每一群有特殊卫生保健需求(CSHCN)的儿童。目的：本研究的主要目的是检验与PCMH护理相一致的照顾者服务经验随时间和儿童特征的变化。研究设计：这是一项横断面汇集数据分析，使用2003-2012年医疗费用小组针对5-17岁CSHCN的调查数据。进行了Logistic回归，考虑了儿童和父母的社会人口、儿童的健康保险和背景特征。结果：31%的儿童报告医疗家庭协调护理，综合(83%)和同情(82%)护理最普遍，最不常见的是无障碍护理(59%)和以患者为中心的护理(60%)。2003至2012年间，全国范围内PCMH协调性护理显著增加，但根据儿童需求和社会人口特征，差异仍然存在。结论：尽管随着时间的推移，父母对护理的感知与医疗之家护理相一致，但在高需求的CSHCN中，差异仍然存在。未来的研究可能集中在更好地理解临床环境如何调整这种护理模式，特别是提供更多的机会和以患者为中心的护理，以更好地为最有需要的儿童服务。
Background:Efforts to transform primary care have been underway for over a decade. Yet, we lack understanding of the progress made in scaling up this care model nationwide and on whether patient-centered medical home (PCMH) has benefited every group of children with special health care needs (CSHCNs).Objective:The main objective of this study was to examine variation in caregiver service experience concordant with PCMH care over time and by child characteristics.Research Design:This was a cross-sectional pooled data analysis using the 2003-2012 Medical Expenditures Panel Survey data for CSHCNs, aged 5-17 years. Logistic regressions were implemented, accounting for child and parent sociodemographic, child's health insurance, and contextual characteristics. PCMH concordant care and each component were constructed as binary variables and child functional impairment was measured with the Columbia Impairment Scale.Results:Thirty-one percent of children reported medical home concordant care; comprehensive (83%) and compassionate (82%) care were most prevalent, and the least common were accessible care (59%) and patient-centered care (60%). PCMH concordant care significantly increased nationwide between 2003 and 2012, but disparities remained based on child needs and sociodemographic characteristics. Multivariate regressions showed variation across medical home components.Conclusions:Despite increased parent perception of care that is concordant with medical home care over time, disparities remain among high-need CSHCNs. Future research may focus on better understanding how clinical settings tailor this care model, particularly on providing increased access and patient-centered care, to better serve children at the highest need.