Department of Pediatrics, St Christopher's Hospital for Children, Drexel University School of Public Heath, 15th and Race Streets, Mail Stop 1032, Philadelphia, PA 19102, USA.
Pediatrics. 2009 Dec;124 Suppl 4:S428-34. doi: 10.1542/peds.2009-1255O.
To examine the association between receiving adequate care coordination (CC) with family-provider relations and family/child outcomes.
We analyzed data from the 2005-2006 National Survey of Children With Special Health Care Needs. Eligible subjects were the 88% of families asked about experience with CC, service use, and communication. Respondents also reported on demographic characteristics, health status, family-provider relations, and family/child outcomes. Weighted, multivariate logistic regression models were constructed to assess independent associations of adequate CC with outcomes.
Among families with children with special health care needs asked about CC, 68.2% reported receiving some type of CC help. Of these, 59.2% reported receiving adequate CC help, and 40.8% reported inadequate CC. Families that reported adequate compared with inadequate CC had increased odds of receiving family-centered care, experiencing partnerships with professionals, and satisfaction with services. They had decreased odds of having problems with referrals for specialty care, missing >6 school days because of illness (previous year), and visiting the emergency department more than twice in the previous 12 months (P < .001). Those who reported adequate compared with inadequate CC had decreased odds of the following: more than $500/y of out-of-pocket expenses, family financial burden, spending more than 4 hours/week coordinating care, and stopping/reducing work hours.
Parental report of adequate CC was associated with favorable family-provider relations and family/child outcomes. Additional efforts are needed to discern which aspects of CC are most beneficial and for which subgroups of children with special health care needs.
探讨接受充分的医患关系协调（CC）与家庭/儿童结局之间的关系。
我们分析了 2005-2006 年全国有特殊健康需求儿童调查的数据。符合条件的研究对象是 88%的被问及 CC 经验、服务使用和沟通的家庭。受访者还报告了人口统计学特征、健康状况、医患关系以及家庭/儿童结局。构建加权多变量逻辑回归模型来评估充分 CC 与结局的独立关联。
在被问及 CC 的有特殊健康需求儿童的家庭中，68.2%报告接受了某种类型的 CC 帮助。其中，59.2%报告接受了充分的 CC 帮助，40.8%报告接受了不充分的 CC。与接受不充分 CC 的家庭相比，报告接受充分 CC 的家庭更有可能接受以家庭为中心的护理、与专业人员建立伙伴关系以及对服务感到满意。他们更不可能出现专业医疗转诊问题、因疾病（前一年）缺课超过 6 天，以及在前 12 个月内去急诊室就诊超过 2 次（P<.001）。与接受不充分 CC 的家庭相比，报告接受充分 CC 的家庭出现以下情况的可能性更小：每年超过 500 美元的自付费用、家庭经济负担、每周用于协调护理的时间超过 4 小时以及停止/减少工作时间。
父母报告的充分 CC 与良好的医患关系和家庭/儿童结局相关。需要进一步努力来辨别 CC 的哪些方面最有益，以及对哪些有特殊健康需求的儿童亚组最有益。
