Quality medical homes: meeting children's needs for therapeutic and supportive services.
OBJECTIVE
The objective of this study was to determine whether the quality of a medical home is associated with access to needed therapeutic and supportive services among children with special health care needs.


METHODS
Data from the 2000-2001 National Survey of Children With Special Health Care Needs were used in the analysis. The primary group of interest was children who were 0 to 17 years of age and needed therapeutic (n = 15,793) or supportive (n = 23,376) services. For each characteristic of a quality medical home, the percentage of children who needed and received therapeutic and supportive services was generated. Logistic regression was used to control for covariates while modeling the association between overall quality of a child's medical home and having unmet needs for therapeutic or supportive services.


RESULTS
Of all children identified as needing services, 16.2% had unmet therapeutic and 9.8% unmet supportive service needs. Only 23.9% of the children who needed therapeutic and 32.5% of children who needed supportive services met the criteria of having a quality medical home. High-quality care within medical homes was associated with a decreased likelihood of having unmet needs for therapeutic and supportive services. Each characteristic of a quality medical home was associated with unmet need, as were severity of the child's condition, family income of <200% of the federal poverty level, underinsurance, and maternal education beyond high school.


CONCLUSIONS
Among other factors, having a poor-quality medical home seems to be a barrier to receiving needed therapeutic or supportive services for children with special health care needs. Efforts on the part of pediatricians to establish quality medical homes for all children could have the added benefit of facilitating access to needed therapeutic and supportive services and promoting the health and well-being of children with special health care needs and their families.
University of Wisconsin, Department of Kinesiology, Program in Occupational Therapy, 3170 Medical Science Center, 1300 University Ave, Madison, WI 53706-1532, USA. rbenedict@education.wisc.edu
Ruth E
RE
Benedict
D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000592:standards* / Q000639:trends; D002669:Child Welfare; D002675:Child, Preschool; D016001:Confidence Intervals; D019988:Children with Disabilities / Q000534:rehabilitation / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D020380:Needs Assessment; D016017:Odds Ratio; D011787:Quality of Health Care; D012042:Registries; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States