title: Care coordination, the family-centered medical home, and functional disability among children with special health care needs.
abstract: BACKGROUND
  Children with special health care needs (CSHCN) are at increased risk for functional disabilities. Care coordination has been shown to decrease unmet health service use but has yet been shown to improve functional status. We hypothesize that care coordination services lower the odds of functional disability for CSHCN and that this effect is greater within the context of a family-centered medical home. A secondary objective was to test the mediating effect of unmet care needs on functional disability.
  
  
  METHODS
  Our sample included children ages 0 to 17 years participating the 2009-2010 National Survey of Children with Special Health Care Needs. Care coordination, unmet needs, and disability were measured by parent report. We used logistic regression models with covariate adjustment for confounding and a mediation analysis approach for binary outcomes to assess the effect of unmet needs.
  
  
  RESULTS
  There were 34,459 children in our sample. Care coordination was associated with lower odds of having a functional disability (adjusted odds ratio 0.82, 95% confidence interval 0.77, 0.88). This effect was greater for care coordination in the context of a medical home (adjusted odds ratio 0.71, 95% confidence interval 0.66, 0.76). The relationship between care coordination and functional disability was mediated by reducing unmet services.
  
  
  CONCLUSIONS
  Care coordination is associated with lower odds of functional disability among CSHCN, especially when delivered in the setting of a family-centered medical home. Reducing unmet service needs mediates this effect. Our findings support a central role for coordination services in improving outcomes for vulnerable children.
authors.affiliation: Harvard School of Public Health, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Mass. Electronic address: jlitt@bidmc.harvard.edu.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Litt
authors.affiliation: Harvard School of Public Health, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Mass.
authors.forename: Marie C
authors.initials: MC
authors.lastname: McCormick
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D003266:Continuity of Patient Care; D019988:Children with Disabilities; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D020380:Needs Assessment; D016017:Odds Ratio; D018802:Patient-Centered Care / Q000458:organization & administration*
keywords: care coordination; children with special health care needs; disability; medical home