A number of characteristics of high-quality health care for children can be combined into the concept of the medical home. As defined by the American Academy of Pediatrics, children's medical care should be accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally effective.1 Multiple studies have shown that having a medical home is associated with improved health care among CSHCN.2
- The survey included several questions that sought to measure whether a child's health care met the criteria for a medical home:
- Whether the child has at least one personal doctor or nurse who knows him or her well,
- Whether the child has a usual source of sick care,
- Whether the child has problems obtaining needed referrals to specialty care, other services, or equipment,
- Whether the family is satisfied with the level of communication among their child's health care providers and other programs, such as schools and support service programs,
- Whether the family receives needed help coordinating a child's care,
- Whether the child's health care providers spend enough time with the family, listen carefully to their concerns, and are sensitive to their values and customs,
- Whether the health care provider supplies the family with enough information,
- Whether the family feels like a partner in their child's care,
- Whether the family receives interpreter services, if needed.
A child was defined as having a medical home if his or her care is reported to meet all of these criteria. Among children without special health care needs, nearly 60 percent (59.4 percent) received care in a medical home. Among CSHCN, 49.8 percent received care that met this standard. CSHCN were significantly less likely to receive care within a medical home, even after statistical adjustment for other differences between CSHCN and non-CSHCN.
Among children whose special needs are more complex - that is, they require more than just prescription medications to manage their conditions — 41.5 percent received care within a medical home (data not shown). The percentage of CSHCN with a medical home ranged across states from 30.3 percent to 61.0 percent.
Among CSHCN, more than half (55.4 percent) of those aged 0-5 years had a medical home, compared to less than half of older children (47.2 percent of those aged 6-11 years and 49.4 percent of those aged 12-17) (data not shown). Uninsured CSHCN were the least likely to receive care in a medical home: only 28.9 percent did so, compared to 42.1 percent of those with public insurance and 56.6 percent of those with private coverage.
CSHCN aged 2-17 with emotional, behavioral, or developmental conditions are less likely to receive care from a medical home than CSHCN without these conditions. Forty percent of CSHCN with at least one of these conditions were reported to have a medical home, compared to 56.4 percent of CSHCN in this age group with none of the seven conditions.
1 Medical Home Initiatives for Children With Special Needs Project Advisory Committee. The Medical Home. Pediatrics. 2002; 184-6.2 Homer CJ et al. A Review of the Evidence for the Medical Home for Children With Special Health Care Needs. Pediatrics. Vol. 122 No. 4 October 2008, pp. e922-e937