Department of Health Outcomes and Policy, University of Florida, 1329 SW 16th Street, Gainesville, FL, 32610, USA,
Matern Child Health J. 2013 Nov;17(9):1658-64. doi: 10.1007/s10995-012-1179-4.
At some point in their lives, nearly one-half of all American children will have a behavioral health condition. Many will not receive the care they need from a fragmented health delivery system. The patient-centered medical home is a promising model to improve their care; however, little evidence exists. Our study aim was to examine the association between several behavioral health indicators and having a patient-centered medical home. 91,642 children's parents or guardians completed the 2007 National Survey of Children's Health. An indicator for patient-centered medical home was included in the dataset. Descriptive statistics, bivariate tests, and multivariate regression models were used in the analyses. Children in the sample were mostly Male (52 %), White (78 %), non-Hispanic (87 %), and did not have a special health care need (80 %). 6.2 % of the sample had at least one behavioral health condition. Conditions ranged from ADHD (6 %) to Autism Spectrum Disorder (ASD) (1 %). Frequency of having a patient-centered medical home also varied for children with a behavioral health condition (49 % of children with ADHD and 33 % of children with ASD). Frequency of having a patient-centered medical home decreased with multiple behavioral health conditions. Higher severity of depression, anxiety, and conduct disorder were associated with a decreased likelihood of a patient-centered medical home. Results from our study can be used to target patient-centered medical home interventions toward children with one or more behavioral health conditions and consider that children with depression, anxiety, and conduct disorder are more vulnerable to these disparities.
在他们生命中的某个时刻，近一半的美国儿童将出现行为健康问题。许多人无法从支离破碎的医疗体系中获得所需的护理。以患者为中心的家庭医疗模式是改善他们护理的有前途的模式；然而，证据很少。我们的研究目的是研究几个行为健康指标与以患者为中心的家庭医疗模式之间的关联。91642 名儿童的父母或监护人完成了 2007 年全国儿童健康调查。数据集包含了一个以患者为中心的家庭医疗模式指标。在分析中使用了描述性统计、双变量检验和多变量回归模型。样本中的儿童主要是男性（52%）、白人（78%）、非西班牙裔（87%），并且没有特殊的医疗需求（80%）。6.2%的样本至少有一种行为健康状况。这些状况从注意力缺陷多动障碍（6%）到自闭症谱系障碍（ASD）（1%）不等。有以患者为中心的家庭医疗模式的儿童的频率也因行为健康状况而异（6%的 ADHD 儿童和 33%的 ASD 儿童）。随着行为健康状况的增加，拥有以患者为中心的家庭医疗模式的频率下降。抑郁、焦虑和品行障碍的严重程度越高，与以患者为中心的家庭医疗模式的可能性降低相关。我们研究的结果可用于针对有一个或多个行为健康问题的儿童开展以患者为中心的家庭医疗模式干预措施，并考虑到患有抑郁、焦虑和品行障碍的儿童更容易受到这些差异的影响。
