title: Care coordination and unmet specialty care among children with special health care needs.
abstract: OBJECTIVE
  Care coordination and the medical home may ensure access to specialty care. Children with special health care needs (CSHCN) have higher rates of specialty care use and unmet need compared with the general pediatric population. We hypothesized that care coordination, regardless of whether it was provided in a medical home, would decrease unmet specialty care needs among CSHCN and that the effect of care coordination would be greater among low-income families.
  
  
  METHODS
  Secondary data analysis of participants in the 2009–2010 National Survey of CSHCN who reported unmet specialty care needs and for whom care coordination and medical home status could be determined (n = 18 905). Logistic regression models explored the association of unmet need with care coordination and medical home status adjusting for household income.
  
  
  RESULTS
  Approximately 9% of CSHCN reported having unmet specialty care needs. Care coordination was associated with reduced odds of unmet specialty care need (without a medical home, odds ratio: 0.63, 95% confidence interval: 0.47–0.86; within a medical home, odds ratio: 0.22, 95% confidence interval: 0.16–0.29) with a greater reduction among those receiving care coordination within a medical home versus those receiving care coordination without a medical home. We did not find differences in the impact of care coordination by percentage of the federal poverty level.
  
  
  CONCLUSIONS
  Care coordination is associated with family report of decreased unmet specialty care needs among CSHCN independent of household income. The effect of care coordination is greater when care is received in a medical home.
authors.forename: Alexy Arauz
authors.initials: AA
authors.lastname: Boudreau
authors.forename: James M
authors.initials: JM
authors.lastname: Perrin
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Goodman
authors.forename: Daniel
authors.initials: D
authors.lastname: Kurowski
authors.forename: W Carl
authors.initials: WC
authors.lastname: Cooley
authors.forename: Karen
authors.initials: K
authors.lastname: Kuhlthau
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D019988:Children with Disabilities / Q000534:rehabilitation* / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D033183:Interdisciplinary Communication; D008297:Male; D008511:Medicine / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D018802:Patient-Centered Care / Q000458:organization & administration*; D011203:Poverty; D014481:United States