Factors Associated with a Patient-Centered Medical Home Among Children with Behavioral Health Conditions

Abstract

At some point in their lives, nearly one-half of all American children will have a behavioral health condition. Many will not receive the care they need from a fragmented health delivery system. The patient-centered medical home is a promising model to improve their care; however, little evidence exists. Our study aim was to examine the association between several behavioral health indicators and having a patient-centered medical home. 91,642 children's parents or guardians completed the 2007 National Survey of Children's Health. An indicator for patient-centered medical home was included in the dataset. Descriptive statistics, bivariate tests, and multivariate regression models were used in the analyses. Children in the sample were mostly Male (52 %), White (78 %), non-Hispanic (87 %), and did not have a special health care need (80 %). 6.2 % of the sample had at least one behavioral health condition. Conditions ranged from ADHD (6 %) to Autism Spectrum Disorder (ASD) (1 %). Frequency of having a patient-centered medical home also varied for children with a behavioral health condition (49 % of children with ADHD and 33 % of children with ASD). Frequency of having a patient-centered medical home decreased with multiple behavioral health conditions. Higher severity of depression, anxiety, and conduct disorder were associated with a decreased likelihood of a patient-centered medical home. Results from our study can be used to target patient-centered medical home interventions toward children with one or more behavioral health conditions and consider that children with depression, anxiety, and conduct disorder are more vulnerable to these disparities.

Family Impacts Among Children With Autism Spectrum Disorder: The Role of Health Care Quality

“…Regression models included socio-demographic variables previously associated with differences in health status, health care quality, or autism severity, 14,30,31 including child age, gender, race/ethnicity/language, household income relative to federal poverty level (FPL), insurance type, and geographic region. We also examined the frequency of the most common health conditions among all CSHCN in all three groups of interest, as well as number of total health conditions (Table 2).…”

Factors Associated with Having a Medical Home for Children At-Risk of Experiencing Negative Events: Results from a National Study

“…Similar to previous studies, child and maternal risks were identified by the following four variables: (1) child health status (fair/poor or excellent/very good/good), (2) maternal general health (fair/poor or excellent/very good/good), (3) maternal mental/emotional health (fair/ poor or excellent/very good/good) and (4) maternal education level (less than high school or high school or higher) [7][8][9]19]. It is important to note that child health status could be considered either a risk factor (i.e., predictor) or outcome of having a medical home.…”

“…The current study similarly examines the effects of negative events that children experience but in relation to their clinical environment. Whereas previous studies show some children have disproportional rates of having a medical home, [6][7][8][9][10]19] our study will examine the relation family and environmental risks, including ACEs, having a medical home. This will add an important piece to the literature so that future research can identify whether having a medical home may be a mediating factor between experiencing negative events and health outcomes.…”

Essential Clinical Guide to Understanding and Treating Autism

“…Yet another set of issues arises for individuals who receive services from various providers and agencies, for example, child psychiatrists, social workers, educators, psychologists, speech pathologists, behavior specialists, and so on. The primary care provider has an increasingly important role in care coordination and provision of a "medical home" (Hyman & Johnson, 2012;Knapp et al, 2013). This book is written to address the needs of primary care providers for what we hope is an accessible and straightforward guide to medical care for individuals with autism, Asperger's, and the broader autism spectrum group of conditions.…”