title: Community health centers: medical homes for children?
abstract: OBJECTIVE
  To explore medical home attributes of community health centers (CHCs) that provide care to low-income children nationwide compared to other providers for the poor.
  
  
  METHODS
  Cross-sectional study of children aged 0 to 17 years in the Medical Expenditure Panel Survey (MEPS; 2003 to 2009) who resided in families living at <200% of the federal poverty level (FPL) and had visits to a primary care setting. CHC visits were defined as a visit to a neighborhood/family health center, rural health clinic, or community health center. Independent measures included provider type, age, gender, race/ethnicity, insurance, FPL, number of parents at home, language, maternal education, health status, and special health care need. Dependent measures included 4 medical home attributes: accessibility, and family-centered, comprehensive, and compassionate care.
  
  
  RESULTS
  CHCs typically serve low-income children who are publicly insured or uninsured, come from racial/ethnic minority groups, and have poorer health status. Eighty percent to 90% of parents visiting both CHCs and other primary care providers rated high levels of family-centered, comprehensive, and compassionate care. However, CHCs had a 10% to 18% lower rating of accessibility (after-hours care, telephone access) even after controlling for sociodemographic characteristics. Racial/ethnic disparities existed at both settings, but these patterns did not differ between CHCs and other settings.
  
  
  CONCLUSIONS
  On the basis of parental reports, CHCs received similar ratings to other primary care providers for family-centered, comprehensive, and compassionate care, but lower ratings for accessibility. Further studies should examine strategies for practice transformation in CHCs to improve patient satisfaction and accessibility to optimize child health outcomes.
authors.affiliation: Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY. Electronic address: leesha_hoilette@urmc.rochester.edu.
authors.forename: Leesha K
authors.initials: LK
authors.lastname: Hoilette
authors.forename: Aaron K
authors.initials: AK
authors.lastname: Blumkin
authors.forename: Constance D
authors.initials: CD
authors.lastname: Baldwin
authors.forename: Kevin
authors.initials: K
authors.lastname: Fiscella
authors.forename: Peter G
authors.initials: PG
authors.lastname: Szilagyi
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003151:Community Health Centers / Q000706:statistics & numerical data*; D003191:Comprehensive Health Care / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004522:Educational Status; D005191:Family Characteristics; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D008297:Male; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D011203:Poverty; D011320:Primary Health Care / Q000706:statistics & numerical data*; D064876:Safety-net Providers / Q000706:statistics & numerical data; D014481:United States
keywords: children; community health centers; medical home; safety net