| A number of the characteristics
of high-quality health care for children can be combined into the
concept of the medical home. As defined by the American Academy
of Pediatrics, children’s medical care should be accessible,
family-centered, continuous, comprehensive, coordinated, compassionate,
and culturally effective.1 The survey
included several questions that sought to measure whether a child’s
health care met this standard:
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Whether the child has at least one personal doctor
or nurse who knows him or her well;
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Whether this personal doctor or nurse usually
or always spends enough time with the family, explains things
so the parent can understand, and provides interpreter services
when needed;
-
Whether this personal doctor or nurse usually
or always provides telephone advice or urgent care when the
child needs it;
-
Whether the child has little or no problem gaining
access to specialty care, services, and/or equipment when it
is needed;
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Whether the personal doctor or nurse followed
up by talking with the family about the child’s specialist
visit and/or use of special services or equipment; and
-
Whether the child had a preventive visit in the
past year.
A child was defined as having a medical home if he or she had at least
one preventive visit in the past year, had little or no problem with
access to specialty care, and reported having a personal doctor or
nurse who usually or always spent enough time and communicated clearly
with families, provided telephone advice or urgent care when needed,
and followed up with the family after the child’s specialty
care visits. Overall, the care of 46.1 percent
of children met this standard. This varies substantially with the
source of children’s health insurance: while more than half
(52.6 percent) of children with private insurance were reported
to have a medical home, only 38.9 percent of children with public
insurance and 23.1 percent of uninsured children had care that met
this standard.
A medical home is particularly important for children
with special health care needs (CSHCN), who are likely to require
specialized care and services, follow-up, and care coordination.
Of parents of CSHCN, 44.2 percent reported that their children had
a medical home, compared to 46.6 percent of children without special
health care needs.
Children’s access to medical homes also appears
to vary by their race and ethnicity. Of White children, the parents
of 52.8 percent report that their care met the criteria for a medical
home, compared to 46.0 percent of multiracial children, 39.4 percent
of Black children, 30.3 percent of Hispanic children, and 41.5 percent
of children of other races.
1 American Academy of Pediatrics, Medical
Home Initiatives for Children with Special Needs Project Advisory
Committee. The medical home. Pediatrics 2002;110(1):184-186. |
