title: Factors Associated with Having a Medical Home for Children At-Risk of Experiencing Negative Events: Results from a National Study.
abstract: OBJECTIVE
  Although the Patient Centered Medical Home is a considered an optimal model for care, some children still do not receive care in this model. Beyond the clinical and practitioner factors known to affect having a medical home, family and environmental risks [referred to as adverse childhood experiences (ACE)] may also be associated with having a medical home. This study's purpose was to examine whether family and environment risks are associated with children having a medical home.
  
  
  METHODS
  Data from the nationally representative, cross-sectional 2011-2012 National Survey of Children's Health telephone survey were used (N = 95,677). Analyses were conducted to describe the sample characteristics and determine the association between family and environmental risks and whether a child has a medical home. A subset of risks were modeled from the seminal study of ACEs.
  
  
  RESULTS
  Nearly one-quarter of parents reported that their children experienced at-least one ACE. Compared to children who experienced no ACEs, children who experienced at least one ACE, or other family and environmental risks, had lower odds of having a medical home than those whom did not. Logistic regressions showed that cumulative ACEs (odds ratio (OR) 0.76; 95 % confidence interval (CI) 0.65-0.90) as well as other family and environmental risks (OR 0.36, 95 % CI 0.26-0.51) were related to lower odds of having a medical home.
  
  
  CONCLUSIONS
  This study suggests that family and environmental risks, including ACEs, impact parental report of a child having a medical home and that a dosage effect may exist. ACEs and other risk factors must be considered when providers care for children at-risk of experiencing negative events, particularly multiple negative events.
authors.affiliation: Department of Neurosurgery, University of Florida, PO Box 100265, Gainesville, FL, 32611, USA. jbaronlee@ufl.edu.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Baron-Lee
authors.affiliation: PA Program, University of Florida, Gainesville, FL, USA.
authors.forename: Brandy
authors.initials: B
authors.lastname: Bonner
authors.affiliation: Penn State University, University Park, PA, USA.
authors.forename: Caprice
authors.initials: C
authors.lastname: Knapp
authors.affiliation: Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Bright
authors.affiliation: University of Central Florida, Orlando, FL, USA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Hinojosa
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008016:Life Change Events; D016015:Logistic Models; D008297:Male; D018802:Patient-Centered Care / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D012307:Risk Factors; D064890:Social Determinants of Health
keywords: Adverse childhood experiences; Health care delivery; Medical home; Primary care; Social determinants of health