Published online December 3, 2007
PEDIATRICS Vol. 121 No. 1 January 2008, pp. e127-e134 (doi:10.1542/peds.2007-0066)
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ARTICLE

Quality Medical Homes: Meeting Children's Needs for Therapeutic and Supportive Services

Ruth E. Benedict, DrPH, OTR

Occupational Therapy Program, Department of Kinesiology, University of Wisconsin, Madison, Wisconsin

OBJECTIVE. The objective of this study was to determine whether the quality of a medical home is associated with access to needed therapeutic and supportive services among children with special health care needs.

METHODS. Data from the 2000–2001 National Survey of Children With Special Health Care Needs were used in the analysis. The primary group of interest was children who were 0 to 17 years of age and needed therapeutic (n = 15793) or supportive (n = 23376) services. For each characteristic of a quality medical home, the percentage of children who needed and received therapeutic and supportive services was generated. Logistic regression was used to control for covariates while modeling the association between overall quality of a child's medical home and having unmet needs for therapeutic or supportive services.

RESULTS. Of all children identified as needing services, 16.2% had unmet therapeutic and 9.8% unmet supportive service needs. Only 23.9% of the children who needed therapeutic and 32.5% of children who needed supportive services met the criteria of having a quality medical home. High-quality care within medical homes was associated with a decreased likelihood of having unmet needs for therapeutic and supportive services. Each characteristic of a quality medical home was associated with unmet need, as were severity of the child's condition, family income of <200% of the federal poverty level, underinsurance, and maternal education beyond high school.

CONCLUSIONS. Among other factors, having a poor-quality medical home seems to be a barrier to receiving needed therapeutic or supportive services for children with special health care needs. Efforts on the part of pediatricians to establish quality medical homes for all children could have the added benefit of facilitating access to needed therapeutic and supportive services and promoting the health and well-being of children with special health care needs and their families.

Key Words: medical home • National Survey of Children With Special Health Care Needs • therapy services • support services

Abbreviations: MCHB—Maternal and Child Health Bureau • CSHCN—children with special health care needs • AAP—American Academy of Pediatrics • NSCSHCN—National Survey of Children With Special Health Care Needs • aOR—adjusted odds ratio • CI—confidence interval

Accepted Jun 12, 2007.