title: Which components of medical homes reduce the time burden on families of children with special health care needs?
abstract: OBJECTIVE
  To examine which components of medical homes affect time families spend arranging/coordinating health care for their children with special health care needs (CSHCNs) and providing health care at home.
  
  
  METHODS
  2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN), a population-based survey of 40,242 CSHCNs.
  
  
  METHODS
  NS-CSHCN is a cross-sectional, observational study. We used generalized ordered logistic regression, testing for nonproportional odds in the associations between each of five medical home components and time burden, controlling for insurance, child health, and sociodemographics.
  
  
  METHODS
  Medical home components were collected using Child and Adolescent Health Measurement Initiative definitions.
  
  
  RESULTS
  Family-centered care, care coordination, and obtaining needed referrals were associated with 15-32 percent lower odds of time burdens arranging/coordinating and 16-19 percent lower odds providing health care. All five components together were associated with lower odds of time burdens, with greater reductions for higher burdens providing care.
  
  
  CONCLUSIONS
  Three of the five medical home components were associated with lower family time burdens arranging/coordinating and providing health care for children with chronic conditions. If the 55 percent of CSHCNs lacking medical homes had one, the share of families with time burdens arranging care could be reduced by 13 percent.
authors.affiliation: Bloustein School of Planning and Public Policy, New Brunswick, NJ.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Miller
authors.forename: Colleen N
authors.initials: CN
authors.lastname: Nugent
authors.forename: Louise B
authors.initials: LB
authors.lastname: Russell
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D013997:Time Factors
keywords: Care coordination; children; chronic illness; family time burden; medical home
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