search text   Advanced Search

This Article Full Text Full Text (PDF) P3Rs: Submit a response Alert me when this article is cited Alert me when P3Rs are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Strickland, B. Articles by Newacheck, P. Search for Related Content PubMed PubMed Citation Articles by Strickland, B. Articles by Newacheck, P. Related Collections Developmental/Behavior

Access to the Medical Home: Results of the National Survey of Children With Special Health Care Needs

Bonnie Strickland, PhD^*, Merle McPherson, MD^*, Gloria Weissman, MA^*, Peter van Dyck, MD^*, Zhihuan J. Huang, MB, PhD, MPH and Paul Newacheck, DrPH

^* Maternal and Child Health Bureau Health, Resources and Services Administration, Washington, DC
Children’s National Medical Center, George Washington University Medical Center, Washington, DC
Institute for Health Policy Studies and Department of Pediatrics, University of California at San Francisco, San Francisco, California

Objective. The purpose of this article is to report the findings of the National Survey of Children With Special Health Care Needs regarding parent perceptions of the extent to which children with special health care needs (CSHCN) have access to a medical home.

Methods. Five criteria, selected to reflect the characteristics of a medical home as defined by the American Academy of Pediatrics (AAP) policy statement on the medical home, were analyzed to describe the extent to which CSHCN receive care characteristic of the medical home concept. These criteria included having 1) a usual place for sick/well care, 2) a personal doctor or nurse, 3) no difficulty in obtaining needed referrals, 4) needed care coordination, and 5) family-centered care received. Items from the Survey were selected and clustered to characterize each of the 5 components. Criteria for each item were established with the requirement that the criteria must be met for all items in a component to receive credit for the component.

Results. Results of the survey indicate that 1) approximately half of CSHCN receive care that meets all 5 components established for medical home; 2) most CSHCN have a usual source of care and a personal doctor or nurse, but other components of the medical home, especially elements of care coordination and family-centered care, are lacking; 3) access to a medical home is significantly affected by race/ethnicity, poverty, and the limitations imposed on daily activity by the child’s special health care need; and 4) parents of children who do have a medical home report significantly less delayed or forgone care, significantly fewer unmet health care needs, and significantly fewer unmet needs for family support services. The 5 components described represent major characteristics of the comprehensive care model recommended for all children by the AAP.

Conclusions. The findings suggest that although some components of the medical home concept have been achieved for most CSHCN, the comprehensive care model described by the AAP policy statement on the medical home is not yet in place for a significant number of CSHCN and their families.

Key Words: children with special health care needs • children • chronic illness • access • medical home • quality of health care

Abbreviations: CSHCN, children with special health care needs • MCHB, Maternal and Child Health Bureau • AAP, American Academy of Pediatrics

This article has been cited by other articles:

				C. J. Homer, K. Klatka, D. Romm, K. Kuhlthau, S. Bloom, P. Newacheck, J. Van Cleave, and J. M. Perrin A Review of the Evidence for the Medical Home for Children With Special Health Care Needs Pediatrics, October 1, 2008; 122(4): e922 - e937. [Abstract] [Full Text] [PDF]

				S. L. Toomey, J. Finkelstein, and K. Kuhlthau Does Connection to Primary Care Matter for Children With Attention-Deficit/Hyperactivity Disorder? Pediatrics, August 1, 2008; 122(2): 368 - 374. [Abstract] [Full Text] [PDF]

				S. Nageswaran, E. J. Silver, and R. E. K. Stein Association of Functional Limitation With Health Care Needs and Experiences of Children With Special Health Care Needs Pediatrics, May 1, 2008; 121(5): 994 - 1001. [Abstract] [Full Text] [PDF]

				A. Gewirtz, E. Hart-Shegos, and A. Medhanie Psychosocial Status of Homeless Children and Youth in Family Supportive Housing American Behavioral Scientist, February 1, 2008; 51(6): 810 - 823. [Abstract] [PDF]

				R. J Graham Specialty services for children with special health care needs: supplement not supplant the medical home Arch. Dis. Child., January 1, 2008; 93(1): 2 - 4. [Full Text] [PDF]

				R. E. Benedict Quality Medical Homes: Meeting Children's Needs for Therapeutic and Supportive Services Pediatrics, January 1, 2008; 121(1): e127 - e134. [Abstract] [Full Text] [PDF]

				L. Monterosso, L. J. Kristjanson, S. Aoun, and M. B. Phillips Supportive and palliative care needs of families of children with life-threatening illnesses in Western Australia: evidence to guide the development of a palliative care service Palliative Medicine, December 1, 2007; 21(8): 689 - 696. [Abstract] [PDF]

				D. Z. Kuo, T. L. Cheng, and P. C. Rowe Successful Use of a Primary Care Practice Specialty Collaboration in the Care of an Adolescent With Chronic Fatigue Syndrome Pediatrics, December 1, 2007; 120(6): e1536 - e1539. [Abstract] [Full Text] [PDF]

				R. A. Zuckerbrot, A. H. Cheung, P. S. Jensen, R. E.K. Stein, D. Laraque, and and the GLAD-PC Steering Group Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification, Assessment, and Initial Management Pediatrics, November 1, 2007; 120(5): e1299 - e1312. [Abstract] [Full Text] [PDF]

				J. A. DePalma Evidence to Support Medical Home Concept for Children With Special Health Care Needs Home Health Care Management Practice, October 1, 2007; 19(6): 473 - 475. [PDF]

				J. B. Gordon, H. H. Colby, T. Bartelt, D. Jablonski, M. L. Krauthoefer, and P. Havens A Tertiary Care Primary Care Partnership Model for Medically Complex and Fragile Children and Youth With Special Health Care Needs Arch Pediatr Adolesc Med, October 1, 2007; 161(10): 937 - 944. [Abstract] [Full Text] [PDF]

				A. E. Brachlow, K. K. Ness, M. L. McPheeters, and J. G. Gurney Comparison of Indicators for a Primary Care Medical Home Between Children With Autism or Asthma and Other Special Health Care Needs: National Survey of Children's Health Arch Pediatr Adolesc Med, April 1, 2007; 161(4): 399 - 405. [Abstract] [Full Text] [PDF]

				A. J. Houtrow, S. E. Kim, A. Y. Chen, and P. W. Newacheck Preventive Health Care for Children With and Without Special Health Care Needs Pediatrics, April 1, 2007; 119(4): e821 - e828. [Abstract] [Full Text] [PDF]

				P. M. Minihan, S. N. Fitch, and A. Must What Does the Epidemic of Childhood Obesity Mean for Children with Special Health Care Needs? J. Law Med. Ethics, March 1, 2007; 35(1): 61 - 77. [PDF]

				N. J. Allred, K. G. Wooten, and Y. Kong The Association of Health Insurance and Continuous Primary Care in the Medical Home on Vaccination Coverage for 19- to 35-Month-Old Children Pediatrics, February 1, 2007; 119(Supplement_1): S4 - S11. [Abstract] [Full Text] [PDF]

				B. A. Mulvihill, M. Altarac, S. Swaminathan, R. S. Kirby, A. Kulczycki, and D. E. Ellis Does Access to a Medical Home Differ According to Child and Family Characteristics, Including Special-Health-Care-Needs Status, Among Children in Alabama? Pediatrics, February 1, 2007; 119(Supplement_1): S107 - S113. [Abstract] [Full Text] [PDF]

				D. Denboba, M. G. McPherson, M. K. Kenney, B. Strickland, and P. W. Newacheck Achieving Family and Provider Partnerships for Children With Special Health Care Needs Pediatrics, October 1, 2006; 118(4): 1607 - 1615. [Abstract] [Full Text] [PDF]

				P. W. Newacheck, J. P. Rising, and S. E. Kim Children at Risk for Special Health Care Needs Pediatrics, July 1, 2006; 118(1): 334 - 342. [Abstract] [Full Text] [PDF]

				P. S. Lye, D. A. Rauch, M. C. Ottolini, C. P. Landrigan, V. W. Chiang, R. Srivastava, S. Muret-Wagstaff, and S. Ludwig Pediatric Hospitalists: Report of a Leadership Conference Pediatrics, April 1, 2006; 117(4): 1122 - 1130. [Abstract] [Full Text] [PDF]

				E. M. Ngui and G. Flores Satisfaction With Care and Ease of Using Health Care Services Among Parents of Children With Special Health Care Needs: The Roles of Race/Ethnicity, Insurance, Language, and Adequacy of Family-Centered Care Pediatrics, April 1, 2006; 117(4): 1184 - 1196. [Abstract] [Full Text] [PDF]

				D. S. Mandell, M. M. Novak, and C. D. Zubritsky Factors Associated With Age of Diagnosis Among Children With Autism Spectrum Disorders Pediatrics, December 1, 2005; 116(6): 1480 - 1486. [Abstract] [Full Text] [PDF]

				M. Lutenbacher, S. Karp, G. Ajero, D. Howe, and M. Williams Crossing Community Sectors: Challenges Faced by Families of Children With Special Health Care Needs Journal of Family Nursing, May 1, 2005; 11(2): 162 - 182. [Abstract] [PDF]

				P. H. Wise The Transformation Of Child Health In The United States Health Aff., September 1, 2004; 23(5): 9 - 25. [Abstract] [Full Text] [PDF]

				P. J. Chung and M. A. Schuster Access And Quality In Child Health Services: Voltage Drops Health Aff., September 1, 2004; 23(5): 77 - 87. [Abstract] [Full Text] [PDF]

	Home | My Pediatrics | Journal Information | Current Issue | Past Issues | Subscriptions & Services | Contact Us Click here for faster international access © 2004 American Academy of Pediatrics. All rights reserved.