Factors Associated with Having a Medical Home for Children At-Risk of Experiencing Negative Events: Results from a Natio
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Factors Associated with Having a Medical Home for Children At-Risk of Experiencing Negative Events: Results from a National Study Jacqueline Baron-Lee1 • Brandy Bonner2 • Caprice Knapp3 • Melissa Bright4 Melanie Hinojosa5
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Published online: 24 May 2015 Ó Springer Science+Business Media New York 2015
Abstract Objectives Although the Patient Centered Medical Home is a considered an optimal model for care, some children still do not receive care in this model. Beyond the clinical and practitioner factors known to affect having a medical home, family and environmental risks [referred to as adverse childhood experiences (ACE)] may also be associated with having a medical home. This study’s purpose was to examine whether family and environment risks are associated with children having a medical home. Methods Data from the nationally representative, crosssectional 2011–2012 National Survey of Children’s Health telephone survey were used (N = 95,677). Analyses were conducted to describe the sample characteristics and determine the association between family and environmental risks and whether a child has a medical home. A subset of risks were modeled from the seminal study of ACEs. Results Nearly one-quarter of parents reported that their children experienced at-least one ACE. Compared to children who experienced no ACEs, children who experienced at least one ACE, or other family and environmental risks, had lower odds of having a medical home than those whom did not. Logistic regressions showed that cumulative
& Jacqueline Baron-Lee [email protected] 1
Department of Neurosurgery, University of Florida, PO Box 100265, Gainesville, FL 32611, USA
2
PA Program, University of Florida, Gainesville, FL, USA
3
Penn State University, University Park, PA, USA
4
Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, USA
5
University of Central Florida, Orlando, FL, USA
ACEs (odds ratio (OR) 0.76; 95 % confidence interval (CI) 0.65–0.90) as well as other family and environmental risks (OR 0.36, 95 % CI 0.26–0.51) were related to lower odds of having a medical home. Conclusions This study suggests that family and environmental risks, including ACEs, impact parental report of a child having a medical home and that a dosage effect may exist. ACEs and other risk factors must be considered when providers care for children at-risk of experiencing negative events, particularly multiple negative events. Keywords Medical home Primary care Health care delivery Adverse childhood experiences Social determinants of health Abbreviations ACE Adverse childhood experiences NSCH National Survey of Children’s Health OR Odds ratio PCMH Patient centered medical home US United States FPL Federal poverty level
Introduction The patient-centered medical home (PCMH) is an optimal model for healthcare, particularly for children and adults with special health care needs [1–6]. This model strengthens primary care by transforming existing models of physician-directed healthcare into a patient-centered model. Key co
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