US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 5600 Fishers Lane, Room 18-41, Rockville, MD 20857, USA.
Pediatrics. 2009 Dec;124 Suppl 4:S352-60. doi: 10.1542/peds.2009-1255E.
In this study we examined geographic disparities in medical home access among US children with special health care needs (CSHCN) aged 0 to 17 years.
The 2005-2006 National Survey of Children With Special Health Care Needs was used to estimate prevalence and odds of not having a medical home and 5 component outcomes according to state. Logistic regression was used to examine individual-level and state-level determinants of access.
Medical home access varied substantially across geographic areas. CSHCN in Alaska, Arizona, Washington, DC, Florida, Illinois, Massachusetts, New Jersey, Nevada, and Virginia had at least 50% higher adjusted odds of not having a medical home than CSHCN in Iowa. The adjusted prevalence of CSHCN lacking a medical home varied from a low of 46% in Iowa and Ohio to a high of 59% in Alaska and 61% in New Jersey. CSHCN in several western and southwestern states experienced greater problems with access to a personal doctor/nurse, a usual source of care, specialty care referrals, care coordination, and family-centered care. Adjustment for age, gender, race/ethnicity, household socioeconomic status, language use, insurance coverage, and functional limitation reduced state disparities in access. CSHCN in states with higher immigrant and non-English-speaking populations had significantly lower medical home access. Increases in state health care expenditure and infrastructure and Medicaid/State Children's Health Insurance Program eligibility were associated with increased access to a personal doctor/nurse.
Although individual-level sociodemographic and state-level health policy variables are important predictors of access, substantial geographic disparities remain, with CSHCN in several western and northeastern states at high risk of not having a medical home.
本研究旨在考察美国 0 至 17 岁有特殊健康需求儿童（CSHCN）获得医疗之家服务的地理差异。
使用 2005-2006 年全国有特殊健康需求儿童调查来估计没有医疗之家的患病率和可能性，并根据州来评估 5 个组成部分的结果。使用逻辑回归来检验获得医疗之家服务的个体和州级决定因素。
医疗之家服务的获得在地理区域上存在显著差异。与爱荷华州的 CSHCN 相比，阿拉斯加、亚利桑那州、华盛顿特区、佛罗里达州、伊利诺伊州、马萨诸塞州、新泽西州、内华达州和弗吉尼亚州的 CSHCN 没有医疗之家的调整后优势比至少高出 50%。缺乏医疗之家的 CSHCN 的调整后患病率从爱荷华州和俄亥俄州的低至 46%到阿拉斯加和新泽西州的高至 59%和 61%不等。几个西部和西南部州的 CSHCN 在获得私人医生/护士、常规医疗服务来源、专科医疗转介、医疗协调和以家庭为中心的护理方面存在更大的问题。调整年龄、性别、种族/民族、家庭社会经济地位、语言使用、保险覆盖范围和功能限制后，州际获得医疗服务的差异有所缩小。在移民和非英语使用人口较多的州，CSHCN 的医疗之家服务获取率显著较低。州级医疗保健支出和基础设施的增加以及医疗补助/州儿童健康保险计划的资格增加与获得私人医生/护士的机会增加有关。
尽管个体层面的社会人口统计学和州级健康政策变量是获得医疗服务的重要预测因素，但仍存在显著的地理差异，西部和东北部几个州的 CSHCN 面临没有医疗之家的高风险。
