Geographic Disparities in Access to the Medical Home Among US CSHCN

Authors:
Publisher website
Google Scholar
Abstract
OBJECTIVES: In this study we examined geographic disparities in medical home access among US children with special health care needs (CSHCN) aged 0 to 17 years. METHODS: The 2005–2006 National Survey of Children With Special Health Care Needs was used to estimate prevalence and odds of not having a medical home and 5 component outcomes according to state. Logistic regression was used to examine individual-level and state-level determinants of access. RESULTS: Medical home access varied substantially across geographic areas. CSHCN in Alaska, Arizona, Washington, DC, Florida, Illinois, Massachusetts, New Jersey, Nevada, and Virginia had at least 50% higher adjusted odds of not having a medical home than CSHCN in Iowa. The adjusted prevalence of CSHCN lacking a medical home varied from a low of 46% in Iowa and Ohio to a high of 59% in Alaska and 61% in New Jersey. CSHCN in several western and southwestern states experienced greater problems with access to a personal doctor/nurse, a usual source of care, specialty care referrals, care coordination, and family-centered care. Adjustment for age, gender, race/ethnicity, household socioeconomic status, language use, insurance coverage, and functional limitation reduced state disparities in access. CSHCN in states with higher immigrant and non–English-speaking populations had significantly lower medical home access. Increases in state health care expenditure and infrastructure and Medicaid/State Children's Health Insurance Program eligibility were associated with increased access to a personal doctor/nurse. CONCLUSIONS: Although individual-level sociodemographic and state-level health policy variables are important predictors of access, substantial geographic disparities remain, with CSHCN in several western and northeastern states at high risk of not having a medical home.

This publication has 17 references indexed in Scilit: