Conrey Elizabeth J, Seidu Dazar, Ryan Norma J, Chapman Dj Sam
Ohio Department of Health, State Epidemiology Office, USA.
J Child Health Care. 2013 Jun;17(2):186-96. doi: 10.1177/1367493512456111. Epub 2012 Dec 12.
Medical homes deliver primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate and culturally effective. Children with special health care needs (CSHCN) require a wide range of support to maintain health, making medical home access particularly important. We sought to understand independent risk factors for lacking access. We analyzed Ohio, USA data from the National Survey of Children with Special Health Care Needs (2005-2006). Among CSHCN, 55.6% had medical home access. The proportion achieving each medical home component was highest for having a personal doctor/nurse and lowest for receiving coordinated care, family-centered care and referrals. Specific subsets of CSHCN were significantly and independently more likely to lack medical home access: Hispanic (AOR=3.08), moderate/high severity of difficulty (AOR=2.84), and any public insurance (AOR=1.60). Efforts to advance medical home access must give special attention to these CSHCN populations and improvements must be made to referral access, family-centered care, and care coordination.
医疗之家提供可及、持续、全面、以家庭为中心、协调、富有同情心且具有文化效力的初级保健。有特殊医疗保健需求的儿童（CSHCN）需要广泛的支持来维持健康，因此获得医疗之家的服务尤为重要。我们试图了解缺乏医疗之家服务的独立风险因素。我们分析了来自美国俄亥俄州的全国特殊医疗保健需求儿童调查（2005 - 2006年）的数据。在有特殊医疗保健需求的儿童中，55.6%能够获得医疗之家的服务。在实现医疗之家的各个组成部分方面，拥有私人医生/护士的比例最高，而获得协调护理、以家庭为中心的护理和转诊服务的比例最低。有特殊医疗保健需求儿童的特定亚组明显且独立地更有可能无法获得医疗之家的服务：西班牙裔（比值比=3.08）、中度/高度困难程度（比值比=2.84）以及任何公共保险（比值比=1.60）。推进医疗之家服务可及性的努力必须特别关注这些有特殊医疗保健需求的儿童群体，并且必须改善转诊服务可及性、以家庭为中心的护理和护理协调。
