Access to the Medical Home Among Children With and Without Special Health Care Needs
Access to the Medical Home Among Children With and Without Special Health Care Needs
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DOI：
10.1542/peds.2018-1795
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发表时间：
2018-12-01
期刊：
影响因子：
8
通讯作者：
Mann, Marie Y.
中科院分区：
文献类型：
--
作者：
Lichstein, Jesse C.;Ghandour, Reem M.;Mann, Marie Y.
卫生：医疗之家是为儿童提供高质量医疗保健的核心。医疗之家的使用情况历来是通过全国有特殊卫生保健需要的儿童调查和全国儿童健康调查来跟踪的。在2012年至2015年期间，NSCH进行了重新设计，将两项调查合并为一项年度评估。在这项研究中，我们提供了最新的估计医疗家庭访问之间的儿童在UnitedStates.METHODS：我们使用的数据从2016年NSCH（N = 50 212）。家庭医疗可及性定义为一项综合指标，由5个子组成部分（常规护理来源、私人医生或护士、转诊可及性、接受护理协调和接受以家庭为中心的护理）组成，涵盖50177名0至17岁的美国儿童。我们进行了双变量分析和逻辑回归，以检查与报告的医疗之家综合指标和每个子成分的实现相关的社会人口学和健康特征。结果：在2016年，有特殊医疗需求的儿童（CSHCN）和非CSHCN儿童中有43.2%和50.0%的儿童有机会到医疗之家就诊。达到的医疗之家综合措施之间的CSHCN和非CSHCN的社会人口学特征显着变化，因为实现率为5个子组成部分。CSHCN的医疗复杂性也与实现率的所有outcome.CONCLUSIONS：医疗之家纳入要素的护理被认为是必要的，提供全面的，优质的护理。我们的研究结果表明，仍有空间，以改善获得医疗之家的所有儿童。
OBJECTIVES: The medical home is central to providing quality health care for children. Access to the medical home has historically been tracked by using the National Survey of Children With Special Health Care Needs and the National Survey of Children's Health (NSCH). Between 2012 and 2015, the NSCH was redesigned, combining the 2 surveys into a single, annual assessment. In this study, we provide the latest estimates of medical home access among children in the United States.METHODS: We used data from the 2016 NSCH (N = 50 212). Medical home access was defined as a composite measure composed of 5 subcomponents (usual source of care, personal doctor or nurse, referral access, receipt of care coordination, and receipt of family-centered care) for 50 177 US children aged 0 to 17 years. We conducted bivariate analyses and logistic regression to examine the sociodemographic and health characteristics associated with reported attainment of the medical home composite measure and each subcomponent. Analyses were survey weighted.RESULTS: In 2016, 43.2% of children with special health care needs (CSHCN) and 50.0% of non-CSHCN were reported to have access to a medical home. Attainment of the medical home composite measure varied significantly by sociodemographic characteristics among both CSHCN and non-CSHCN, as did attainment rates for each of the 5 subcomponents. The medical complexity of CSHCN was also associated with attainment rates of all outcomes.CONCLUSIONS: The medical home incorporates elements of care considered necessary for providing comprehensive, quality care. Our results indicate that there is still room to improve access to the medical home among all children.