title: Family-Centered Care Measurement and Associations With Unmet Health Care Need Among US Children.
abstract: Family-centered care (FCC), including shared decision making (SDM), has become increasingly emphasized in pediatric health care delivery. Past studies using national surveys have used different FCC measurement approaches without determining their validity. We, therefore, sought to develop an FCC measurement model with Medical Expenditure Panel Survey (MEPS) items previously used to assess FCC or SDM; and to determine temporal associations of FCC with unmet health care need.
  
  
  
  Four longitudinal MEPS data files (2007-2011) were combined. The study sample included 15,764 US children aged 0 to 17 years. Eight items assessed FCC, and 5 items assessed unmet health care need. We performed exploratory factor analyses to develop an FCC measurement model and fit a cross-lagged structural equation model to determine temporal associations between FCC and unmet health care need.
  
  
  
  Results supported a 2-factor FCC model including family-provider communication and SDM. The family-provider communication factor was indicated by items reflecting general communication between the child's doctor and family. The SDM factor was indicated by items reflecting decision-making about the child's health care. Adjusted cross-lagged structural equation model results showed family-provider communication and SDM were associated with a reduced likelihood of unmet health care need the following year. Unmet health care need was not significantly associated with family-provider communication or SDM the subsequent year.
  
  
  
  Study results support differentiating between family-provider communication and SDM as interrelated aspects of FCC in future pediatric health care quality measurement and improvement. Family-provider communication and SDM may reduce the likelihood of unmet health care need the following year among US children.
authors.affiliation: School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Ore; Divison of General Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Ore. Electronic address: lindlyo@oregonstate.edu.
authors.forename: Olivia J
authors.initials: OJ
authors.lastname: Lindly
authors.affiliation: School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Ore.
authors.forename: G John
authors.initials: GJ
authors.lastname: Geldhof
authors.affiliation: School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Ore.
authors.forename: Alan C
authors.initials: AC
authors.lastname: Acock
authors.affiliation: School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Ore.
authors.forename: Kari-Lyn K
authors.initials: KK
authors.lastname: Sakuma
authors.affiliation: Divison of General Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Ore.
authors.forename: Katharine E
authors.initials: KE
authors.lastname: Zuckerman
authors.affiliation: School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Ore.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Thorburn
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D003657:Decision Making; D005163:Factor Analysis, Statistical; D005190:Family / Q000523:psychology; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D020380:Needs Assessment; D018802:Patient-Centered Care; D011368:Professional-Family Relations; D011787:Quality of Health Care; D011795:Surveys and Questionnaires / Q000592:standards*; D014481:United States
keywords: family-centered care; pediatric health care quality measurement; shared decision making; structural equation modeling; unmet health care need