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Matern Child Health J. 2015 Oct;19(10):2233-42. doi: 10.1007/s10995-015-1742-x.

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

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Department of Neurosurgery, University of Florida, PO Box 100265, Gainesville, FL, 32611, USA.
PA Program, University of Florida, Gainesville, FL, USA.
Penn State University, University Park, PA, USA.
Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, USA.
University of Central Florida, Orlando, FL, USA.



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.


Data from the nationally representative, cross-sectional 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.


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 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.


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.


Adverse childhood experiences; Health care delivery; Medical home; Primary care; Social determinants of health

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