Published online February 1, 2007
PEDIATRICS Vol. 119 Supplement February 2007, pp. S107-S113 (doi:10.1542/peds.2006-2089P)
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SUPPLEMENT ARTICLE


Does Access to a Medical Home Differ According to Child and Family Characteristics, Including Special-Health-Care-Needs Status, Among Children in Alabama?

Beverly A. Mulvihill, PhDa, Maja Altarac, MD, PhDa, Shailender Swaminathan, PhDa, Russell S. Kirby, PhDa, Andrzej Kulczycki, PhDa and Dawn E. Ellis, MPHb

a Department of Maternal and Child Health, School of Public Health, University of Alabama, Birmingham, Alabama
b Alabama Department of Rehabilitation Services, Children's Rehabilitation Services, Montgomery, Alabama

OBJECTIVE. Our goal was to examine relationships among access to a medical home, special-health-care-needs status, and child and family characteristics in one Southern state. We hypothesized that access to a medical home is influenced by several family and child sociodemographic characteristics, including special-health-care status.

METHODS. We used data from the 2003 National Survey of Children's Health. The study sample comprised all Alabama resident children. The main dependent variable was a medical home; the primary independent variable classified children according to children-with-special-health-care-needs status. We controlled for child age, gender, race, family structure, health status, insurance coverage, household education, and poverty. We first explored means or proportions for the study variables and then estimated multivariate logistic regression models.

RESULTS. Children with special health care needs were significantly more likely than children without special health care needs to have a personal doctor or nurse, to have a preventive health care visit in the previous 12 months, and to have good communication with their provider. Children with special health care needs were also more likely to experience problems accessing specialty care, equipment, or services. Being uninsured, living at or near the federal poverty level, in a household where no one completed high school, being black, having less than excellent or good health, and living in a nontraditional family structure were characteristics associated with being less likely to have a medical home. In general, children-with-special-health-care-needs status was not related to having a medical home, but dependency on prescription medicine was.

CONCLUSIONS. Assuring that all children, irrespective of family income, have access to and are enrolled in health insurance plans will move us closer to the national goal of having a medical home for all children, especially those with a special health care need, by 2010.

Key Words: medical home • children with special health care needs • insurance

Abbreviations: CSHCN—children with special health care needs • AAP—American Academy of Pediatrics • MCHB—Maternal and Child Health Bureau • NSCH—National Survey of Children's Health • FPL—federal poverty level • CI—confidence interval • OR—odds ratio • aOR—adjusted odds ratio • CRS—Children's Rehabilitation Service

Accepted Sep 15, 2006.