优质医疗之家：满足儿童对治疗和支持性服务的需求。

Quality medical homes: meeting children's needs for therapeutic and supportive services.

作者信息

Benedict Ruth E

机构信息

University of Wisconsin, Department of Kinesiology, Program in Occupational Therapy, 3170 Medical Science Center, 1300 University Ave, Madison, WI 53706-1532, USA.

出版信息

Pediatrics. 2008 Jan;121(1):e127-34. doi: 10.1542/peds.2007-0066. Epub 2007 Dec 3.

DOI:10.1542/peds.2007-0066

PMID:18056291

Abstract

OBJECTIVE

The objective of this study was to determine whether the quality of a medical home is associated with access to needed therapeutic and supportive services among children with special health care needs.

METHODS

Data from the 2000-2001 National Survey of Children With Special Health Care Needs were used in the analysis. The primary group of interest was children who were 0 to 17 years of age and needed therapeutic (n = 15,793) or supportive (n = 23,376) services. For each characteristic of a quality medical home, the percentage of children who needed and received therapeutic and supportive services was generated. Logistic regression was used to control for covariates while modeling the association between overall quality of a child's medical home and having unmet needs for therapeutic or supportive services.

RESULTS

Of all children identified as needing services, 16.2% had unmet therapeutic and 9.8% unmet supportive service needs. Only 23.9% of the children who needed therapeutic and 32.5% of children who needed supportive services met the criteria of having a quality medical home. High-quality care within medical homes was associated with a decreased likelihood of having unmet needs for therapeutic and supportive services. Each characteristic of a quality medical home was associated with unmet need, as were severity of the child's condition, family income of <200% of the federal poverty level, underinsurance, and maternal education beyond high school.

CONCLUSIONS

Among other factors, having a poor-quality medical home seems to be a barrier to receiving needed therapeutic or supportive services for children with special health care needs. Efforts on the part of pediatricians to establish quality medical homes for all children could have the added benefit of facilitating access to needed therapeutic and supportive services and promoting the health and well-being of children with special health care needs and their families.

摘要

目的

本研究的目的是确定医疗之家的质量是否与有特殊医疗需求的儿童获得所需治疗和支持性服务的机会相关。

方法

分析使用了2000 - 2001年全国有特殊医疗需求儿童调查的数据。主要关注的群体是0至17岁且需要治疗性服务（n = 15,793）或支持性服务（n = 23,376）的儿童。对于优质医疗之家的每个特征，计算了需要并获得治疗性和支持性服务的儿童百分比。在对儿童医疗之家的总体质量与治疗或支持性服务需求未得到满足之间的关联进行建模时，使用逻辑回归来控制协变量。

结果

在所有被确定需要服务的儿童中，16.2%的儿童治疗性服务需求未得到满足，9.8%的儿童支持性服务需求未得到满足。需要治疗性服务的儿童中只有23.9%，需要支持性服务的儿童中只有32.5%符合优质医疗之家的标准。医疗之家中的高质量护理与治疗性和支持性服务需求未得到满足的可能性降低相关。优质医疗之家的每个特征都与需求未得到满足相关，儿童病情的严重程度、家庭收入低于联邦贫困水平的200%、保险不足以及母亲受过高中以上教育也与需求未得到满足相关。