title: The role of medical home in emergency department use for children with developmental disabilities in the United States.
abstract: OBJECTIVE
  Children with developmental disabilities (DDs) have higher rates of emergency department use (EDU) than their typically developing peers do. This study sought to elucidate the relationship between EDU frequency and access to a comprehensive medical home for children with DD.
  
  
  METHODS
  This study conducted multivariate logistic regression analysis on data from the 2005-2006 National Survey of Children with Special Health Care Needs to explore the association between EDU frequency among children with DD and medical home.
  
  
  RESULTS
  Compared with children with DD reporting zero EDU, children with 3 or more EDU were less likely to report access to usual health care source (adjusted odds ratio [AOR], 0.63; 95% confidence interval [CI], 0.45-0.88). Moreover, children with DD who had 3 or more EDU were less likely to have clinicians who listen to parental concerns (AOR, 0.58; 95% CI, 0.45-0.76), demonstrate sensitivity toward family values and customs (AOR = 0.60, 95% CI = 0.46, 0.78), and build meaningful family partnerships (AOR, 0.69; 95% CI, 0.53-0.89).
  
  
  CONCLUSIONS
  The study suggests that children with DD reporting 3 or more EDU per year would likely reduce their EDU by having access to usual source of primary care services and to clinicians with skills in building meaningful partnership with the parents. The inclusion of these medical home attributes in the adoption of patient-centered medical homes with the implementation of the Affordable Care Act presents a mechanism to improve care at lower cost as well as facilitate chronic disease management and coordination between emergency medicine and primary care physicians that may lead to reductions in EDU and unnecessary hospitalization.
authors: From the *Bureau of Primary Health Care and †Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD.
authors: Sue C
authors: SC
authors: Lin
authors: Benyamin
authors: B
authors: Margolis
authors: Stella M
authors: SM
authors: Yu
authors: Terry A
authors: TA
authors: Adirim
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000628:therapy; D001321:Autistic Disorder / Q000628:therapy; D002547:Cerebral Palsy / Q000628:therapy; D003142:Communication; D003430:Cross-Sectional Studies; D002658:Developmental Disabilities / Q000628:therapy*; D004314:Down Syndrome / Q000628:therapy; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D008607:Intellectual Disability / Q000628:therapy; D016015:Logistic Models; D015999:Multivariate Analysis; D009136:Muscular Dystrophies / Q000628:therapy; D018802:Patient-Centered Care; D011368:Professional-Family Relations; D014481:United States