Department of Pediatrics, University of California, San Francisco, CA 94143, USA.
Acad Pediatr. 2013 Mar-Apr;13(2):113-21. doi: 10.1016/j.acap.2012.11.004. Epub 2013 Jan 29.
The importance of the medical home for children has been demonstrated but has not been examined comprehensively for adolescents. Adolescence is a unique period of physical, cognitive, and psychosocial changes when many mental disorders first emerge; thus, receiving care within a medical home could improve well-being. This study examines rates of medical home attainment and its components for adolescents and subgroups, including those with mental health conditions.
Utilizing the 2007 National Survey of Children's Health, we determined the following for adolescents aged 10 to 17 years (n = 45 897): 1) rates of medical home attainment and its 5 components (usual source of care, having a personal doctor, and receiving needed referrals, effective care coordination, and family-centered care); and 2) subgroup differences; gender, race/ethnicity, income, insurance, region, language spoken at home, respondent education, and the presence of mental health conditions.
Fifty-four percent of adolescents had a past-year medical home. Rates were lower for minority youth compared to whites; lower-income and uninsured youth; those in households that are non-English speaking in which the respondent did not have some college; and those with mental health as opposed to physical health conditions (all P < .01). Patterns of disparities in the medical home components were similar, and rates were lowest for effective care coordination and family-centered care components.
Nearly half of adolescents lacked a medical home in the past year. Even lower rates for subgroups highlight the need to increase access to comprehensive quality health care. Efforts to improve effective care coordination and family-centered care could result in higher quality of care for all children and adolescents, and specifically for disadvantaged adolescents and those with mental health conditions.
儿童的医疗之家的重要性已经得到证明，但尚未对青少年进行全面检查。青春期是身体、认知和心理社会变化的独特时期，许多精神障碍最初在此期间出现；因此，在医疗之家接受护理可以改善幸福感。本研究检查了医疗之家的获得率及其组成部分，包括有心理健康状况的青少年和亚组。
利用 2007 年全国儿童健康调查，我们确定了以下 10 至 17 岁青少年（n=45897）的情况：1）医疗之家获得率及其 5 个组成部分（常规就诊来源、有私人医生以及获得所需转诊、有效护理协调和以家庭为中心的护理）；2）亚组差异；性别、种族/族裔、收入、保险、地区、家庭语言、受访者教育程度以及心理健康状况。
54%的青少年在过去一年中有医疗之家。与白人相比，少数民族青年的比率较低；收入较低和没有保险的青年；家庭不讲英语，受访者没有大学学历；以及患有心理健康而非身体健康状况的青年（均 P<.01）。医疗之家组成部分的差异模式相似，有效护理协调和以家庭为中心的护理组成部分的比率最低。
近一半的青少年在过去一年中没有医疗之家。亚组的比率更低，突显了增加获得全面优质医疗保健的机会的必要性。努力改善有效护理协调和以家庭为中心的护理可以提高所有儿童和青少年的护理质量，特别是对处境不利的青少年和有心理健康状况的青少年。
