School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Ore; Divison of General Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Ore.
School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Ore.
Acad Pediatr. 2017 Aug;17(6):656-664. doi: 10.1016/j.acap.2016.10.018. Epub 2017 Mar 30.
Family-centered care (FCC), including shared decision making (SDM), has become increasingly emphasized in pediatric health care delivery. Past studies using national surveys have used different FCC measurement approaches without determining their validity. We, therefore, sought to develop an FCC measurement model with Medical Expenditure Panel Survey (MEPS) items previously used to assess FCC or SDM; and to determine temporal associations of FCC with unmet health care need.
Four longitudinal MEPS data files (2007-2011) were combined. The study sample included 15,764 US children aged 0 to 17 years. Eight items assessed FCC, and 5 items assessed unmet health care need. We performed exploratory factor analyses to develop an FCC measurement model and fit a cross-lagged structural equation model to determine temporal associations between FCC and unmet health care need.
Results supported a 2-factor FCC model including family-provider communication and SDM. The family-provider communication factor was indicated by items reflecting general communication between the child's doctor and family. The SDM factor was indicated by items reflecting decision-making about the child's health care. Adjusted cross-lagged structural equation model results showed family-provider communication and SDM were associated with a reduced likelihood of unmet health care need the following year. Unmet health care need was not significantly associated with family-provider communication or SDM the subsequent year.
Study results support differentiating between family-provider communication and SDM as interrelated aspects of FCC in future pediatric health care quality measurement and improvement. Family-provider communication and SDM may reduce the likelihood of unmet health care need the following year among US children.
以家庭为中心的护理（FCC），包括共同决策（SDM），在儿科医疗保健服务中越来越受到重视。过去使用全国性调查的研究使用了不同的 FCC 测量方法，但没有确定其有效性。因此，我们试图使用之前用于评估 FCC 或 SDM 的医疗支出调查（MEPS）项目来开发 FCC 测量模型；并确定 FCC 与未满足的医疗需求之间的时间关联。
合并了四个纵向 MEPS 数据文件（2007-2011 年）。研究样本包括 15764 名年龄在 0 至 17 岁的美国儿童。八项措施评估 FCC，五项措施评估未满足的医疗需求。我们进行了探索性因素分析，以开发 FCC 测量模型，并拟合交叉滞后结构方程模型，以确定 FCC 和未满足的医疗需求之间的时间关联。
结果支持包括家庭-提供者沟通和 SDM 的两因素 FCC 模型。家庭-提供者沟通因素由反映儿童医生与家庭之间一般沟通的项目表示。SDM 因素由反映儿童医疗保健决策的项目表示。调整后的交叉滞后结构方程模型结果表明，家庭-提供者沟通和 SDM 与次年未满足的医疗需求的可能性降低相关。未满足的医疗需求与家庭-提供者沟通或 SDM 次年没有显著相关。
研究结果支持在未来儿科医疗保健质量测量和改进中，将家庭-提供者沟通和 SDM 区分开来作为 FCC 的相互关联方面。家庭-提供者沟通和 SDM 可能会降低美国儿童次年未满足医疗需求的可能性。
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