Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland
Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland.
Pediatrics. 2018 Dec;142(6). doi: 10.1542/peds.2018-1795.
: media-1vid110.1542/5840358562001PEDS-VA_2018-1795 OBJECTIVES: The medical home is central to providing quality health care for children. Access to the medical home has historically been tracked by using the National Survey of Children With Special Health Care Needs and the National Survey of Children's Health (NSCH). Between 2012 and 2015, the NSCH was redesigned, combining the 2 surveys into a single, annual assessment. In this study, we provide the latest estimates of medical home access among children in the United States.
We used data from the 2016 NSCH ( = 50 212). Medical home access was defined as a composite measure composed of 5 subcomponents (usual source of care, personal doctor or nurse, referral access, receipt of care coordination, and receipt of family-centered care) for 50 177 US children aged 0 to 17 years. We conducted bivariate analyses and logistic regression to examine the sociodemographic and health characteristics associated with reported attainment of the medical home composite measure and each subcomponent. Analyses were survey weighted.
In 2016, 43.2% of children with special health care needs (CSHCN) and 50.0% of non-CSHCN were reported to have access to a medical home. Attainment of the medical home composite measure varied significantly by sociodemographic characteristics among both CSHCN and non-CSHCN, as did attainment rates for each of the 5 subcomponents. The medical complexity of CSHCN was also associated with attainment rates of all outcomes.
The medical home incorporates elements of care considered necessary for providing comprehensive, quality care. Our results indicate that there is still room to improve access to the medical home among all children.
媒体-1vid110.1542/5840358562001PEDS-VA_2018-1795 目的：医疗之家是为儿童提供优质医疗保健的核心。历史上，通过使用《国家特殊保健需要儿童调查》和《国家儿童健康调查》（NSCH）来跟踪获得医疗之家的途径。在 2012 年至 2015 年期间，NSCH 进行了重新设计，将这两项调查合并为一项年度评估。在这项研究中，我们提供了美国儿童获得医疗之家途径的最新估计。
我们使用了 2016 年 NSCH（=50212）的数据。医疗之家的途径被定义为由 5 个子成分（通常的医疗来源、个人医生或护士、转介途径、获得护理协调和获得以家庭为中心的护理）组成的复合指标，用于 50177 名年龄在 0 至 17 岁的美国儿童。我们进行了双变量分析和逻辑回归，以检查与报告获得医疗之家复合指标和每个子成分相关的社会人口统计学和健康特征。分析采用了调查加权。
在 2016 年，有特殊保健需要的儿童（CSHCN）中有 43.2%和非 CSHCN 中有 50.0%被报告获得医疗之家的途径。在 CSHCN 和非 CSHCN 中，医疗之家复合指标的获得情况因社会人口统计学特征而有显著差异，5 个子成分的获得率也存在差异。CSHCN 的医疗复杂性也与所有结果的获得率有关。
医疗之家包含了被认为是提供全面、优质护理所必需的护理要素。我们的结果表明，所有儿童获得医疗之家的途径仍有改进的空间。
