Published online May 26, 2009
PEDIATRICS Vol. 123 No. 6 June 2009, pp. e996-e1004 (doi:10.1542/peds.2008-2504)
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ARTICLE

Access to the Medical Home: New Findings From the 2005-2006 National Survey of Children With Special Health Care Needs

Bonnie B. Strickland, PhDa, Gopal K. Singh, PhDa, Michael D. Kogan, PhDa, Marie Y. Mann, MD, MPHa, Peter C. van Dyck, MD, MPHa and Paul W. Newacheck, DrPHb,c

a Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
b Institute for Health Policy Studies
c Department of Pediatrics, University of California, San Francisco, California

OBJECTIVE. This article reports new findings from the 2005–2006 National Survey of Children with Special Health Care Needs (NS-CSHCN) regarding parental perceptions of the extent to which children with special health care needs (CSHCN) have access to a medical home.

METHODS. Five criteria were analyzed to describe the extent to which CSHCN receive care characteristic of the medical home concept. Data on 40840 children included in the NS-CSHCN were used to assess the presence of a medical home, as indicated by achieving each of the 5 criteria.

RESULTS. Results of the survey indicate that (1) approximately one half of CSHCN receive care that meets all 5 criteria established for a medical home; (2) access to a medical home is affected significantly by race/ethnicity, income, health insurance status, and severity of the child's condition; (3) parents of children who do have a medical home report significantly less delayed or forgone care and significantly fewer unmet needs for health care and family support services; and (4) limited improvements have occurred since success rates were first measured by using the 2001 NS-CSHCN.

CONCLUSIONS. The findings suggest that, although some components of the medical home concept have been achieved for most CSHCN, care synonymous with the principles underlying the medical home is not yet in place for a significant number of CSHCN and their families.

Key Words: community pediatrics • health care delivery/access • health policy • medical home • children with special health care needs

Abbreviations: CSHCN—children with special health care needs • NS-CSHCN—National Survey of Children with Special Health Care Needs • MCHB—Maternal and Child Health Bureau • OR—odds ratio

Accepted Feb 10, 2009.


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