title: Factors associated with a patient-centered medical home among children with behavioral health conditions.
abstract: At some point in their lives, nearly one-half of all American children will have a behavioral health condition. Many will not receive the care they need from a fragmented health delivery system. The patient-centered medical home is a promising model to improve their care; however, little evidence exists. Our study aim was to examine the association between several behavioral health indicators and having a patient-centered medical home. 91,642 children's parents or guardians completed the 2007 National Survey of Children's Health. An indicator for patient-centered medical home was included in the dataset. Descriptive statistics, bivariate tests, and multivariate regression models were used in the analyses. Children in the sample were mostly Male (52 %), White (78 %), non-Hispanic (87 %), and did not have a special health care need (80 %). 6.2 % of the sample had at least one behavioral health condition. Conditions ranged from ADHD (6 %) to Autism Spectrum Disorder (ASD) (1 %). Frequency of having a patient-centered medical home also varied for children with a behavioral health condition (49 % of children with ADHD and 33 % of children with ASD). Frequency of having a patient-centered medical home decreased with multiple behavioral health conditions. Higher severity of depression, anxiety, and conduct disorder were associated with a decreased likelihood of a patient-centered medical home. Results from our study can be used to target patient-centered medical home interventions toward children with one or more behavioral health conditions and consider that children with depression, anxiety, and conduct disorder are more vulnerable to these disparities.
authors.affiliation: Department of Health Outcomes and Policy, University of Florida, 1329 SW 16th Street, Gainesville, FL, 32610, USA, caprice1@ufl.edu.
authors.forename: Caprice
authors.initials: C
authors.lastname: Knapp
authors.forename: Lindsey
authors.initials: L
authors.lastname: Woodworth
authors.forename: Daniel
authors.initials: D
authors.lastname: Fernandez-Baca
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Baron-Lee
authors.forename: Lindsay
authors.initials: L
authors.lastname: Thompson
authors.forename: Melanie
authors.initials: M
authors.lastname: Hinojosa
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019988:Children with Disabilities / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D018802:Patient-Centered Care / Q000592:standards*; D058996:Quality Improvement; D012044:Regression Analysis