Florida Atlantic University, School of Social Work, 777 Glades Road, Boca Raton, FL 33341, United States.
Soc Sci Med. 2010 Feb;70(4):631-41. doi: 10.1016/j.socscimed.2009.10.054. Epub 2009 Nov 24.
One in five U.S. households with children has at least one child with a special health care need (USDHHS, 2004). Like most parents, those with children with special health care needs struggle to balance child-rearing responsibilities with employment demands. This research examines factors affecting married parents' and single-mother's employment change decisions focusing specifically on whether having a medical home influences these decisions. This study includes 38,569 children with special health care needs from birth through age 17 surveyed in the 2005-2006 National Survey of Children with Special Health Care Needs. The employment model is estimated using multinomial logistic regression with the choice of a parent to maintain their current level of employment, reduce work hours, or stop working as the dependent variable. Independent variables are those characterizing the needs of the child, the resources of the family, and the socio-demographic characteristics of the family. Components of the medical home variable include: 1) having a usual source of care; 2) care provided is "family centered"; 3) receipt of care coordination services; and 4) receipt of needed referrals. Half of the children in our sample met criteria in all four facets. If the child has a medical home, the relative risk of a parent choosing to cut hours rather than not change hours decreases by 51%. The relative risk of choosing to stop working rather than not change hours decreases by an estimated 64%. Care coordination services significantly reduce the odds of changing employment status. Our results suggest that the medical home is a moderating factor in parental decisions concerning change in employment status.
五分之一有孩子的美国家庭至少有一个孩子有特殊的医疗需求（USDHHS，2004 年）。与大多数父母一样，那些有特殊健康需求的孩子的父母努力平衡育儿责任和就业需求。这项研究考察了影响已婚父母和单身母亲就业变化决策的因素，特别关注是否有医疗之家会影响这些决策。本研究包括了从出生到 17 岁的 38569 名患有特殊健康需求的儿童，他们在 2005-2006 年全国特殊健康需求儿童调查中接受了调查。就业模型是使用多项逻辑回归估计的，选择父母保持当前就业水平、减少工作时间或停止工作作为因变量。自变量是那些描述孩子需求、家庭资源和家庭社会人口特征的变量。医疗之家变量的组成部分包括：1）有一个常规的医疗来源；2）提供的护理是以“家庭为中心”的；3）接受护理协调服务；4）获得所需的转介。我们样本中的一半孩子在所有四个方面都符合标准。如果孩子有医疗之家，那么父母选择减少工作时间而不是不改变工作时间的相对风险降低 51%。选择停止工作而不是不改变工作时间的相对风险估计降低了 64%。护理协调服务显著降低了就业状况改变的几率。我们的研究结果表明，医疗之家是父母在就业状况改变决策中的一个调节因素。
