title: Geographic disparities in access to the medical home among US CSHCN.
abstract: OBJECTIVE
  In this study we examined geographic disparities in medical home access among US children with special health care needs (CSHCN) aged 0 to 17 years.
  
  
  METHODS
  The 2005-2006 National Survey of Children With Special Health Care Needs was used to estimate prevalence and odds of not having a medical home and 5 component outcomes according to state. Logistic regression was used to examine individual-level and state-level determinants of access.
  
  
  RESULTS
  Medical home access varied substantially across geographic areas. CSHCN in Alaska, Arizona, Washington, DC, Florida, Illinois, Massachusetts, New Jersey, Nevada, and Virginia had at least 50% higher adjusted odds of not having a medical home than CSHCN in Iowa. The adjusted prevalence of CSHCN lacking a medical home varied from a low of 46% in Iowa and Ohio to a high of 59% in Alaska and 61% in New Jersey. CSHCN in several western and southwestern states experienced greater problems with access to a personal doctor/nurse, a usual source of care, specialty care referrals, care coordination, and family-centered care. Adjustment for age, gender, race/ethnicity, household socioeconomic status, language use, insurance coverage, and functional limitation reduced state disparities in access. CSHCN in states with higher immigrant and non-English-speaking populations had significantly lower medical home access. Increases in state health care expenditure and infrastructure and Medicaid/State Children's Health Insurance Program eligibility were associated with increased access to a personal doctor/nurse.
  
  
  CONCLUSIONS
  Although individual-level sociodemographic and state-level health policy variables are important predictors of access, substantial geographic disparities remain, with CSHCN in several western and northeastern states at high risk of not having a medical home.
authors: US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 5600 Fishers Lane, Room 18-41, Rockville, MD 20857, USA. gsingh@hrsa.gov
authors: Gopal K
authors: GK
authors: Singh
authors: Bonnie B
authors: BB
authors: Strickland
authors: Reem M
authors: RM
authors: Ghandour
authors: Peter C
authors: PC
authors: van Dyck
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D002675:Child, Preschool; D006291:Health Policy; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data*; D006306:Health Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D012923:Social Class; D014481:United States