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Geographic disparities in access to the medical home among US CSHCN
Gopal K Singh1, Bonnie B Strickland, Reem M Ghandour
1US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 5600 Fishers Lane, Room 18-41, Rockville, MD 20857, USA. gsingh@hrsa.gov
Insights
Geographic disparities exist in medical home access for US children with special health care needs. States like Iowa and Ohio offer better access, while western and northeastern states show higher risks.
Area of Science:
- Pediatric Health Services Research
- Health Disparities
- Healthcare Access
Background:
- Medical home is a crucial model of primary care for children with special health care needs (CSHCN).
- Geographic variations in healthcare access can significantly impact health outcomes for vulnerable populations.
- Understanding these disparities is essential for developing targeted interventions.
Purpose of the Study:
- To examine geographic disparities in medical home access among US children with special health care needs (CSHCN) aged 0 to 17 years.
- To identify state-level factors associated with variations in medical home access.
Main Methods:
- Utilized data from the 2005-2006 National Survey of Children With Special Health Care Needs.
- Employed logistic regression to analyze individual- and state-level determinants of medical home access and its components.
- Estimated prevalence and odds of lacking a medical home across different US states.
Main Results:
- Significant geographic disparities in medical home access were observed across US states.
- CSHCN in states like Alaska, New Jersey, and Florida had substantially higher odds of lacking a medical home compared to those in Iowa.
- Factors such as state immigrant population, non-English speaking populations, and healthcare expenditure influenced access.
- Western and southwestern states showed greater challenges in accessing personal doctors, specialty care, and care coordination.
Conclusions:
- Despite controlling for individual and state-level variables, substantial geographic disparities in medical home access persist.
- CSHCN in certain western and northeastern states remain at a higher risk of not having a medical home.
- Policy interventions addressing state-level health infrastructure and eligibility are associated with improved access.
Objectives:
In this study we examined geographic disparities in medical home access among US children with special health care needs (CSHCN) aged 0 to 17 years.
Methods:
The 2005-2006 National Survey of Children With Special Health Care Needs was used to estimate prevalence and odds of not having a medical home and 5 component outcomes according to state. Logistic regression was used to examine individual-level and state-level determinants of access.
Results:
Medical home access varied substantially across geographic areas. CSHCN in Alaska, Arizona, Washington, DC, Florida, Illinois, Massachusetts, New Jersey, Nevada, and Virginia had at least 50% higher adjusted odds of not having a medical home than CSHCN in Iowa. The adjusted prevalence of CSHCN lacking a medical home varied from a low of 46% in Iowa and Ohio to a high of 59% in Alaska and 61% in New Jersey. CSHCN in several western and southwestern states experienced greater problems with access to a personal doctor/nurse, a usual source of care, specialty care referrals, care coordination, and family-centered care. Adjustment for age, gender, race/ethnicity, household socioeconomic status, language use, insurance coverage, and functional limitation reduced state disparities in access. CSHCN in states with higher immigrant and non-English-speaking populations had significantly lower medical home access. Increases in state health care expenditure and infrastructure and Medicaid/State Children's Health Insurance Program eligibility were associated with increased access to a personal doctor/nurse.
Conclusions:
Although individual-level sociodemographic and state-level health policy variables are important predictors of access, substantial geographic disparities remain, with CSHCN in several western and northeastern states at high risk of not having a medical home.
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