Bradford W David, Kaste Linda M, Nietert Paul J
Department of Health Administration and Policy, Medical University of South Carolina, Charleston, SC 29425, USA.
Med Care. 2004 Jan;42(1):91-8. doi: 10.1097/01.mlr.0000102368.39193.5a.
The study seeks to evaluate whether continuity in medical care provides a mechanism that contributes to increased parental awareness of the importance of dental services, nutrition, and child development and whether health insurance encourages such continuity.
Data pertaining to medical utilization and dental, child nutrition, and child development counseling were extracted from the National Maternal and Infant Health Survey, 1988 and the 1991 Longitudinal Follow-up. These data permit the investigation of whether having continuity in medical care for a child increases the likelihood that the child's parent receives advice about dental health, nutrition, and child development. Restricting the analyses to Caucasian and African American women and excluding respondents with missing information on the child's health care utilization yielded 7056 participants. We created a set of binomial logit models, with correction for clustering (due to sample design). These models jointly estimate the likelihood that a child was classified as having continuity of care and the likelihood that the child's mother received advice about the 3 areas of interest.
Private fee-for-service health insurance was found to increase the likelihood that a child receives continuity of care. When primary care was provided with high continuity of care, the probability that physicians provide mothers with dental, nutritional, and developmental advice was increased.
These results suggest that continuity of care may have important spillover effects beyond direct medical care by improving maternal information about child dental care, nutrition, and developmental issues.
本研究旨在评估医疗连续性是否提供了一种机制，有助于提高父母对牙科服务、营养和儿童发育重要性的认识，以及医疗保险是否鼓励这种连续性。
从1988年全国母婴健康调查和1991年纵向随访中提取有关医疗利用、牙科、儿童营养和儿童发育咨询的数据。这些数据有助于调查儿童医疗的连续性是否会增加儿童父母接受有关牙齿健康、营养和儿童发育建议的可能性。将分析限制在白种人和非裔美国女性，并排除儿童医疗利用信息缺失的受访者，得到7056名参与者。我们创建了一组二项逻辑模型，并对聚类进行了校正（由于样本设计）。这些模型共同估计了儿童被归类为具有医疗连续性的可能性以及儿童母亲接受有关三个感兴趣领域建议的可能性。
发现私人按服务收费医疗保险会增加儿童获得医疗连续性的可能性。当初级保健提供高度的医疗连续性时，医生向母亲提供牙科、营养和发育建议的可能性会增加。
这些结果表明，医疗连续性可能通过改善母亲关于儿童牙科护理、营养和发育问题的信息，产生超出直接医疗护理的重要溢出效应。
