Medical homes for children with special healthcare needs in North Carolina.
BACKGROUND
The American Academy of Pediatrics defines a medical home as medical care for children that is accessible, continuous, comprehensive, family-centered, coordinated, and compassionate. North Carolina uses the medical home concept as a model for providing high quality care to children with special healthcare needs (CSHCN). However, until recently, information on medical homes for CSHCN in North Carolina has not been available.


METHODS
Using North Carolina data from the National Survey of Children with Special Health Care Needs (2000-2002), we describe the characteristics of children having a special healthcare need. We conducted bivariate analysis of socio-demographic factors with medical home and its five components (family-centered care, effective care coordination, personal doctor or nurse, usual source of care, and referrals for specialty care) and multivariate analysis to identify the predictors of having a medical home.


RESULTS
Fifty-six percent of CSHCN in North Carolina have a medical home. White CSHCN are 1.7 times more likely to have a medical home compared to non-white CSHCN. CSHCN with no functional limitations are 1.6 times more likely to have a medical home compared to children with some or severe limitations of their functional status.


CONCLUSIONS
Current, population-based information about CSHCN and their families is essential for assessing needs and evaluating pediatric initiatives at the state level. Disparities among CSHCN due to race and functional status should be considered in organizing services for CSHCN in North Carolina.
Nageswaran
Savithri
S
Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27517, USA. snageswa@wfubmc.edu
Roth
Marcia S
MS
Kluttz-Hile
Catherine E
CE
Farel
Anita
A
D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D003191:Comprehensive Health Care / Q000706:statistics & numerical data*; D019988:Children with Disabilities; D005190:Family; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D009657:North Carolina; D016017:Odds Ratio; D018802:Patient-Centered Care; D010372:Pediatrics / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*