Limbers C A, Zeleznik T, Beuley G, Milliken A, Hernandez E, Ryan-Pettes S R
Department of Psychology and Neuroscience, Baylor University, One Bear Place #97334, Waco, TX, 76798, USA.
J Clin Psychol Med Settings. 2025 Jun;32(2):211-217. doi: 10.1007/s10880-024-10035-3. Epub 2024 Aug 7.
Early diagnosis of autism spectrum disorder (ASD) in children facilitates the provision of services and enhances opportunities for improving functioning via intervention. To date, limited studies have examined whether age of ASD diagnosis is associated with components of care of the patient-centered medical home (PCMH), a model of health care that emphasizes centralized, accessible, and coordinated care. The objective of the current study was to evaluate the associations between components of the PCMH and age of ASD diagnosis while controlling for associated clinical and socio-demographic factors, in a national sample of children 17 years and younger with ASD. The present study was a cross-sectional, observational study. Participants were caregivers of 1,193 children ages with ASD from the 2020 National Survey of Children's Health (NSCH). Hierarchical multiple linear regression analysis was run with age of ASD diagnosis as the criterion variable in two regression models. The binary composite medical home proxy variable was investigated as well as the five individual medical home components (usual source of care, personal doctor or nurse, family-centered care, care coordination, able to obtain referrals when needed). In the first regression analysis, the overall PCMH proxy variable was significantly correlated with the age of ASD diagnosis (standardized beta coefficient = -.08; p < .01). Of the five components of the PCMH assessed in the second regression model, only usual source of sick care was significantly associated with the age of ASD diagnosis (standardized beta coefficient = -.11; p < .01). Having a usual source of sick care may be an important factor in receiving an earlier ASD diagnosis for children and adolescents.
儿童自闭症谱系障碍（ASD）的早期诊断有助于提供服务，并通过干预增加改善功能的机会。迄今为止，仅有有限的研究探讨了ASD诊断年龄是否与以患者为中心的医疗之家（PCMH）的护理组成部分相关，PCMH是一种强调集中、可及和协调护理的医疗保健模式。本研究的目的是在全国17岁及以下患有ASD的儿童样本中，在控制相关临床和社会人口学因素的同时，评估PCMH的组成部分与ASD诊断年龄之间的关联。本研究为横断面观察性研究。参与者是来自2020年全国儿童健康调查（NSCH）的1193名患有ASD儿童的照顾者。在两个回归模型中，以ASD诊断年龄作为标准变量进行分层多元线性回归分析。研究了二元复合医疗之家代理变量以及五个医疗之家组成部分（通常的医疗服务来源、私人医生或护士、以家庭为中心的护理、护理协调、需要时能够获得转诊）。在第一次回归分析中，总体PCMH代理变量与ASD诊断年龄显著相关（标准化β系数 = -0.08；p < 0.01）。在第二次回归模型中评估的PCMH的五个组成部分中，只有通常的疾病护理来源与ASD诊断年龄显著相关（标准化β系数 = -0.11；p < 0.01）。对于儿童和青少年来说，有一个通常的疾病护理来源可能是更早获得ASD诊断的一个重要因素。
