title: Does access to a medical home differ according to child and family characteristics, including special-health-care-needs status, among children in Alabama?
abstract: OBJECTIVE
  Our goal was to examine relationships among access to a medical home, special-health-care-needs status, and child and family characteristics in one Southern state. We hypothesized that access to a medical home is influenced by several family and child sociodemographic characteristics, including special-health-care status.
  
  
  METHODS
  We used data from the 2003 National Survey of Children's Health. The study sample comprised all Alabama resident children. The main dependent variable was a medical home; the primary independent variable classified children according to children-with-special-health-care-needs status. We controlled for child age, gender, race, family structure, health status, insurance coverage, household education, and poverty. We first explored means or proportions for the study variables and then estimated multivariate logistic regression models.
  
  
  RESULTS
  Children with special health care needs were significantly more likely than children without special health care needs to have a personal doctor or nurse, to have a preventive health care visit in the previous 12 months, and to have good communication with their provider. Children with special health care needs were also more likely to experience problems accessing specialty care, equipment, or services. Being uninsured, living at or near the federal poverty level, in a household where no one completed high school, being black, having less than excellent or good health, and living in a nontraditional family structure were characteristics associated with being less likely to have a medical home. In general, children-with-special-health-care-needs status was not related to having a medical home, but dependency on prescription medicine was.
  
  
  CONCLUSIONS
  Assuring that all children, irrespective of family income, have access to and are enrolled in health insurance plans will move us closer to the national goal of having a medical home for all children, especially those with a special health care need, by 2010.
authors.affiliation: Department of Maternal and Child Health, School of Public Health, University of Alabama, Birmingham, Alabama 35294-0022, USA. bmulvihi@uab.edu
authors.forename: Beverly A
authors.initials: BA
authors.lastname: Mulvihill
authors.forename: Maja
authors.initials: M
authors.lastname: Altarac
authors.forename: Shailender
authors.initials: S
authors.lastname: Swaminathan
authors.forename: Russell S
authors.initials: RS
authors.lastname: Kirby
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kulczycki
authors.forename: Dawn E
authors.initials: DE
authors.lastname: Ellis
mesh_terms: D000293:Adolescent; D000407:Alabama; D002648:Child; D002675:Child, Preschool; D019988:Children with Disabilities / Q000706:statistics & numerical data; D005190:Family; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010372:Pediatrics / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors