Factors Associated With Having A Medical Home For Children At-Risk Of Experiencing Negative Events: Results From A National Study

Keywords

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

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.

Publication Date

10-26-2015

Publication Title

Maternal and Child Health Journal

Volume

19

Issue

10

Number of Pages

2233-2242

Document Type

Article

Personal Identifier

scopus

DOI Link

https://doi.org/10.1007/s10995-015-1742-x

Socpus ID

84942363647 (Scopus)

Source API URL

https://api.elsevier.com/content/abstract/scopus_id/84942363647

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