title: Immigrant Families, Children With Special Health Care Needs, and the Medical Home.
abstract: OBJECTIVE
  Immigrant children in the United States historically experience lower-quality health care. Such disparities areconcerning for immigrant children with special health care needs (CSHCNs). Our study assesses the medical home presence for CSHCN by immigrant family type and evaluates which medical home components are associated with disparities.
  
  
  METHODS
  We used the 2011 National Survey of Children's Health, comparing the prevalence and odds of a parent-reported medical home and 5 specific medical home components by immigrant family types using bivariate and multivariate logistic regression.
  
  
  RESULTS
  Foreign-born CSHCNs were less likely than CSHCNs with US-born parents to have a medical home (adjusted odds ratio = 0.40, 95% confidence interval 0.19-0.85). The adjusted prevalence of having a medical home was 28% among foreign-born CSHCNs (P < .05) and 37% among CSHCNs with a foreign-born parent (P < .001), compared with 49% among CSHCNs with US-born parents. Foreign-born children without special needs also had a lower odds of a medical home, compared with children with US-born parents (adjusted odds ratio = 0.62, 0.46-0.83). The medical home component most frequently absent for immigrant children without special needs and CSHCNs with a foreign-born parent was family-centered care. In contrast, foreign-born CSHCNs most often lacked care coordination (adjusted prevalence = 37% versus 56% for CSHCNs with US-born parents; P < .05).
  
  
  CONCLUSIONS
  Disparities in medical home presence for CSHCNs appear to be exacerbated by immigrant family type. Efforts focused on improving family-centered care and care coordination may provide the greatest benefit for immigrant CSHCNs.
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, Child Health Evaluation and Research Unit, Department of Pediatrics and Communicable Diseases, kristika@umich.edu.
authors.forename: Kristin
authors.initials: K
authors.lastname: Kan
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine.
authors.forename: Hwajung
authors.initials: H
authors.lastname: Choi
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, Child Health Evaluation and Research Unit, Department of Pediatrics and Communicable Diseases, Department of Internal Medicine, Institute for Healthcare Policy and Innovation, Gerald R. Ford School of Public Policy, and School of Public Health, University of Michigan, Ann Arbor, Michigan.
authors.forename: Matthew
authors.initials: M
authors.lastname: Davis
mesh_terms: D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D054242:Emigrants and Immigrants; D005192:Family Health; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D054525:Minority Health; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D014481:United States