Comparing medical homes for children with ADHD and asthma.
OBJECTIVE
The aims of our study were, among children with attention-deficit/hyperactivity disorder (ADHD) compared with children with asthma: 1) to assess characteristics associated with parent report of having a medical home for children with either of these 2 conditions; 2) to determine whether, controlling for these characteristics, the likelihood of having a medical home differs between children with ADHD and asthma; and 3) to identify the specific components of a medical home that are lacking for children with these 2 conditions.


METHODS
Cross-sectional analysis of the National Survey of Children with Special Health Care Needs, 2005-2006 (NS-CSHCN) was used. The outcome variable was parent report of their child's practice having specific attributes of the medical home. We used multivariate logistic regression to test whether the likelihood of having a medical home and its components differed for children with ADHD in comparison to children with asthma.


RESULTS
The NS-CSHCN interviewed parents of 11 674 children with ADHD and 13 517 children with asthma aged between 4 to 17 years. Significantly fewer children with ADHD compared with children with asthma have a medical home (OR [odds ratio] 0.68; P < .001). Specifically, parents reported differences in receiving family-centered (OR 0.79; P < .001) and coordinated care (OR 0.59; P < .001).


CONCLUSIONS
Parents of children with ADHD report worse performance across key dimensions of primary care compared with parents of children with asthma. For primary care to be optimally effective in addressing the needs of children with ADHD, efforts to significantly strengthen these key dimensions are needed.
Children's Hospital Boston, Harvard Medical School, Mass. 02215, USA. sara.toomey@childrens.harvard.edu
Sara L
SL
Toomey
Charles J
CJ
Homer
Jonathan A
JA
Finkelstein
D000293:Adolescent; D001249:Asthma / Q000453:epidemiology / Q000628:therapy*; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage; D016015:Logistic Models; D008297:Male; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology