Expanded efforts needed to provide medical homes for children

Findings of a large national survey reinforce the need for continued and expanded efforts to ensure that all children have access to a medical home.

The medical home is increasingly recognized as the standard for provision of high-quality, comprehensive health care. Using data from the 2007 National Survey of Children’s Health, researchers assessed medical home access and the relationship between the presence of a medical home and selected health care outcomes.

The medical home measure used in the survey included 5 components designed to approximate the definition used by the American Academy of Pediatrics: A usual source of care; a personal physician or nurse; referrals for specialty care; help in coordinating health and health-related care; and family-centered care. Data on 83,448 children aged 1 to 17 years were included in the analysis published online in Pediatrics.

In 2007, 56.9% of US children aged 1 to 17 years (approximately 38 million) had a medical home. Higher proportions had 1 or more of the individual components. Younger children were more likely than older ones to have a medical home, and substantial differences were found in medical home attainment among racial/ethnic, socioeconomic, and health status groups. Children in fair or poor health who conceivably could benefit most from having a medical home were only half as likely as those in excellent or very good health to have one.

Children without a medical home were nearly 4 times more likely than those with a medical home to have an unmet medical need (6.4% vs 1.6%, respectively) and 3 times more likely to have an unmet dental need (4.8% vs 1.5%, respectively). Those without a medical home also were less likely to have had a medical or dental preventive care visit in the past year.

The researchers concluded that targeted initiatives are needed to address disadvantaged segments of the child population.

Strickland BB, Jones JR, Ghandour RM, Kogan MD, Newacheck PW. The medical home: health care access and impact for children and youth in the United States. Pediatrics. 2011. Epub ahead of print.