title: Medical home for adolescents: low attainment rates for those with mental health problems and other vulnerable groups.
abstract: BACKGROUND
  The importance of the medical home for children has been demonstrated but has not been examined comprehensively for adolescents. Adolescence is a unique period of physical, cognitive, and psychosocial changes when many mental disorders first emerge; thus, receiving care within a medical home could improve well-being. This study examines rates of medical home attainment and its components for adolescents and subgroups, including those with mental health conditions.
  
  
  METHODS
  Utilizing the 2007 National Survey of Children's Health, we determined the following for adolescents aged 10 to 17 years (n = 45 897): 1) rates of medical home attainment and its 5 components (usual source of care, having a personal doctor, and receiving needed referrals, effective care coordination, and family-centered care); and 2) subgroup differences; gender, race/ethnicity, income, insurance, region, language spoken at home, respondent education, and the presence of mental health conditions.
  
  
  RESULTS
  Fifty-four percent of adolescents had a past-year medical home. Rates were lower for minority youth compared to whites; lower-income and uninsured youth; those in households that are non-English speaking in which the respondent did not have some college; and those with mental health as opposed to physical health conditions (all P < .01). Patterns of disparities in the medical home components were similar, and rates were lowest for effective care coordination and family-centered care components.
  
  
  CONCLUSIONS
  Nearly half of adolescents lacked a medical home in the past year. Even lower rates for subgroups highlight the need to increase access to comprehensive quality health care. Efforts to improve effective care coordination and family-centered care could result in higher quality of care for all children and adolescents, and specifically for disadvantaged adolescents and those with mental health conditions.
authors: Department of Pediatrics, University of California, San Francisco, CA 94143, USA. adamss@peds.ucsf.edu
authors: Sally H
authors: SH
authors: Adams
authors: Paul W
authors: PW
authors: Newacheck
authors: M Jane
authors: MJ
authors: Park
authors: Claire D
authors: CD
authors: Brindis
authors: Charles E
authors: CE
authors: Irwin
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000706:statistics & numerical data*; D001741:Black or African American; D002648:Child; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006630:Hispanic or Latino; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008913:Minority Groups / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D035862:Vulnerable Populations