Determining an association between having a medical home and uncontrolled asthma in US school-aged children: a population-based study using data from the National Survey of Children's Health.
BACKGROUND
The American Academy of Pediatrics and the American Academy of Family Physicians believe that infants, children, and adolescents benefit from having a medical home, characterized by accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care. Several studies suggest that patients with asthma benefit from having a medical home. However, no national study has been conducted examining the relationships between having a medical home and asthma control in school-aged children with asthma. The purpose of this study was to examine the hypothesis that having an adequate medical home is protective against uncontrolled asthma in children.


METHODS
To test this hypothesis, cross-sectional data from the 2003-2004 National Survey of Children's Health were analyzed. Analyses entailed creating the variables "medical home" as well as "uncontrolled asthma" from multiple variables. Multivariate analysis was performed using children with uncontrolled asthma as the dependent variable.


RESULTS
The logistic regression model performed yielded that school-aged children with uncontrolled asthma were more likely to: speak a primary language other than English (OR, 1.069; 95% CI, 1.045-1.093); live in households with incomes<100% of the federal poverty level (FPL) (OR, 1.826; 95% CI, 1.810-1.842); not have health insurance (OR, 2.296; 95% CI, 2.263-2.330); live in rural rather than metropolitan areas (OR, 1.275; 95% CI, 1.262-1.287); and be non-Caucasian (OR, 2.067; 95% CI, 2.050-2.085). Multivariate analysis also yielded that children with uncontrolled asthma were more likely to have a medical home (OR, 1.138; 95% CI, 1.128-1.148).


CONCLUSIONS
After controlling for possible confounding variables, this study did not detect an association between having a medical home and asthma control for children with asthma aged 5 to 17 years. Additional research should examine the relationship between variables, such as poverty, place of residence, health insurance status, and the medical home, not only in the instance of uncontrolled asthma, but for other childhood health conditions.
Lutfiyya
M Nawal
MN
Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. nlutfiyya@wrha.mb.ca
Scott
Nicole
N
Hurliman
Brett
B
McCullough
Joel Emery
JE
Zeitz
Howard Jerome
HJ
Lipsky
Martin S
MS
D000293:Adolescent; D000367:Age Factors; D001249:Asthma / Q000453:epidemiology / Q000517:prevention & control*; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D018802:Patient-Centered Care; D011320:Primary Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D012574:Schools; D013334:Students; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology