title: The impact of realized access to care on health-related quality of life: a two-year prospective cohort study of children in the California State Children's Health Insurance Program.
abstract: OBJECTIVE
  To examine the effect of realized access to care (problems getting care, access to needed care) on health-related quality of life (HRQOL) in the California State Children's Health Insurance Program.
  
  
  METHODS
  This was a prospective cohort study (n = 4,925; 70.5% [3438] had complete data). Surveys were taken at enrollment and after 1 and 2 years in the program. Parents and children reported HRQOL (PedsQL 4.0 Generic Core Scales). Repeated-measures analysis accounted for within-person correlation and adjusted for baseline PedsQL, baseline realized access, race/ethnicity, language, chronic health condition, and having a regular physician.
  
  
  RESULTS
  Realized access to care during the prior year was related to HRQOL for each subsequent year. Foregone care and problems getting care were associated with decrements of 3.5 (P < .001) and 4.5 (P < .001) points for parent proxy-report PedsQL and with decrements of 3.2 (P < .001) and 4.4 (P < .001) points for child self-report PedsQL. Improved realized access resulted in higher PedsQL scores, continued realized access resulted in sustained PedsQL scores, and foregone care resulted in cumulative declines in PedsQL scores.
  
  
  CONCLUSIONS
  Realized access to care is associated with statistically significant and clinically meaningful changes in HRQOL in children enrolled in the California State Children's Health Insurance Program.
authors.affiliation: RAND Corporation, 1776 Main Street, M4W, Santa Monica, CA 90407, USA. mseid@rand.org
authors.forename: Michael
authors.initials: M
authors.lastname: Seid
authors.forename: James W
authors.initials: JW
authors.lastname: Varni
authors.forename: Lesley
authors.initials: L
authors.lastname: Cummings
authors.forename: Matthias
authors.initials: M
authors.lastname: Schonlau
mesh_terms: D000293:Adolescent; D002140:California; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D007348:Insurance, Health; D008297:Male; D011788:Quality of Life; D013221:State Health Plans; D014481:United States