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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.

Author information

1
Department of Neurosurgery, University of Florida, PO Box 100265, Gainesville, FL, 32611, USA. jbaronlee@ufl.edu.
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.

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, 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.

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 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:

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

PMID:
26003318
DOI:
10.1007/s10995-015-1742-x
[Indexed for MEDLINE]

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