Walker Ashley, Peden John G, Emter Morgan, Colquitt Gavin
Department of Community Health Education and Behavior, Georgia Southern University, Statesboro, GA, United States.
School of Human Ecology, Georgia Southern University, Statesboro, GA, United States.
Front Public Health. 2018 Jun 7;6:170. doi: 10.3389/fpubh.2018.00170. eCollection 2018.
The purpose of this study was to examine predictors of coordinated and comprehensive care within a medical home among children with special health care needs (CSHCN). The latest version of the National Survey of Children with Special Health Care Needs (NS-CSHCN) employed a national random-digit-dial sample whereby US households were screened, resulting in 40,242 eligible respondents. Logistic regression analyses were performed modeling the probability of coordinated, comprehensive care in a medical home based on shared decision-making and other factors. A total of 29,845 cases were selected for inclusion in the model. Of these, 17,390 cases (58.3%) met the criteria for coordinated, comprehensive care in a medical home. Access to a community-based service systems had the greatest positive impact on coordinated, comprehensive care in a medical home. Adequate insurance coverage and being White/Caucasian were also positively associated with the dependent variable. Shared decision-making was reported by 72% of respondents and had a negative, but relatively negligible impact on coordinated, comprehensive care in a medical home. Increasing age, non-traditional family structures, urban residence, and public insurance were more influential, and negatively impacted the dependent variable. Providers and their respective organizations should seek to expand and improve health and support services at the community level.
本研究的目的是调查有特殊医疗需求儿童（CSHCN）在医疗之家获得协调和全面护理的预测因素。最新版的全国特殊医疗需求儿童调查（NS-CSHCN）采用全国随机数字拨号样本，对美国家庭进行筛选，最终有40242名合格受访者。进行了逻辑回归分析，根据共同决策和其他因素对在医疗之家获得协调、全面护理的可能性进行建模。总共选择了29845个案例纳入模型。其中，17390个案例（58.3%）符合在医疗之家获得协调、全面护理的标准。获得基于社区的服务系统对在医疗之家获得协调、全面护理有最大的积极影响。充足的保险覆盖范围以及是白人/高加索人与因变量也呈正相关。72%的受访者报告了共同决策，其对在医疗之家获得协调、全面护理有负面影响，但相对较小。年龄增长、非传统家庭结构、城市居住和公共保险的影响更大，且对因变量有负面影响。医疗服务提供者及其各自的组织应寻求在社区层面扩大和改善健康及支持服务。
