title: Patient-Centered Medical Home and Family Burden in Attention-Deficit Hyperactivity Disorder.
abstract: OBJECTIVE
  Attention-deficit hyperactivity disorder (ADHD) can impair child health and functioning, but its effects on the family's economic burden are not well understood. The authors assessed this burden in US families of children with ADHD, and the degree to which access to a patient-centered medical home (PCMH) might reduce this burden.
  
  
  METHODS
  We conducted cross-sectional analyses of 2005-2006 and 2009-2010 National Surveys of Children with Special Health Care Needs, focusing on families of children with ADHD. They defined family economic burden as (1) family financial problems (annual expenses for the child's health care or illness-related financial problems for the family) and/or (2) family employment problems (job loss, work time loss, or failure to change jobs to avoid insurance loss). Relative risk models assessed associations between PCMH and family economic burden, adjusted for child age, sex, ethnicity, ADHD severity, poverty status, caregiver education, and insurance.
  
  
  RESULTS
  In 2009, 26% of families reported financial problems because of the child's ADHD, 2.1% reported out-of-pocket expenses >5% of income, and 36% reported employment problems. Only 38% reported care that met all 5 criteria for a PCMH (similar to rates in 2005-2006). In multivariable analysis, care in a PCMH was associated with 48% lower relative risk (RR) of financial problems (RR = 0.52, p < .001) and 36% lower relative risk of employment problems (RR = 0.64, p < .001). Among PCMH components, family-centered care and care coordination were more strongly associated with lower burden.
  
  
  CONCLUSIONS
  The economic burdens of families with ADHD are significant but may be alleviated by family-centered care and care coordination in a medical home.
authors.affiliation: *Division of General Pediatrics and Adolescent Medicine, Rainbow Babies and Children's Hospital, Department of Pediatrics, Case Western Reserve University, Cleveland, OH; †Division of General Pediatrics, Department of Pediatrics, University of Rochester, Rochester, NY; ‡Child and Adolescent Health Policy, Massachusetts General Hospital, Boston, MA; §Division of General Pediatrics, Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Sarah D
authors.initials: SD
authors.lastname: Ronis
authors.forename: Constance D
authors.initials: CD
authors.lastname: Baldwin
authors.forename: Aaron
authors.initials: A
authors.lastname: Blumkin
authors.forename: Karen
authors.initials: K
authors.lastname: Kuhlthau
authors.forename: Peter G
authors.initials: PG
authors.lastname: Szilagyi
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000191:economics* / Q000451:nursing*; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004651:Employment / Q000706:statistics & numerical data*; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D014481:United States