title: Disparities in Quality and Access to Care for Children with Developmental Disabilities and Multiple Health Conditions.
abstract: The Maternal Child Health Bureau identified six indicators of quality and accessibility essential in achieving coordinated, family-centered, community-based care for children with special healthcare needs (CSHCN). Previous research examined associations between children with single conditions and individual indicators. We sought to identify disparities in meeting quality and accessibility indicators for children with different condition types.
  
  
  
  The 2009-2010 National Survey of CSHCN is a nationally representative cross-sectional study with caregiver's reports on 40,242 children (0-17 years). Children were categorized into one of seven conditions groups: physical health (PHC), mental health (MHC), developmental disability (DD), physical and mental (PHC and MHC), physical and developmental (PHC and DD), mental and developmental (MHC and DD) and physical, mental and developmental (PHC, MHC, and DD). Unadjusted and adjusted analyses determined associations between condition group and quality and access indicators.
  
  
  
  Children with DD, alone or in combination with another condition, were significantly less likely to meet each indicator (p < 0.01) after adjusting for individual demographic, child's activity limitations and family-related characteristics. Compared with children with PHC, those with all three conditions (PHC, MHC, and DD) had the lowest odds of access to medical home (61 % decreased odds (DO)), community services (67 % DO), and adequate insurance (26 % DO); MHC and DD had the lowest odds of partnering in decision making (51 % DO); DD had the lowest odds of healthcare transition service (66 % DO).
  
  
  
  Children with DD and multiple conditions experience disparities in quality and access to healthcare services, meeting most indictors half as often as other CSHCN.
authors.affiliation: Department of Health Sciences, University of Missouri, 510 Clark Hall, Columbia, MO, 65211, USA. cheakzamoran@health.missouri.edu.
authors.forename: Nancy C
authors.initials: NC
authors.lastname: Cheak-Zamora
authors.affiliation: Department of Health Sciences, University of Missouri, 510 Clark Hall, Columbia, MO, 65211, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Thullen
mesh_terms: D000293:Adolescent; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019988:Children with Disabilities / Q000534:rehabilitation*; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans; D007223:Infant; D008297:Male; D019984:Quality Indicators, Health Care / Q000639:trends; D011787:Quality of Health Care / Q000592:standards*; D060305:Transition to Adult Care / Q000592:standards; D014481:United States
keywords: Children with special health care needs; Maternal and child health; Quality of care