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Factors Associated with Having a Medical Home for Children At-Risk of Experiencing Negative Events: Results from a National Study

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Abstract

Objectives

Although the Patient Centered Medical Home is a considered an optimal model for care, some children still do not receive care in this model. Beyond the clinical and practitioner factors known to affect having a medical home, family and environmental risks [referred to as adverse childhood experiences (ACE)] may also be associated with having a medical home. This study’s purpose was to examine whether family and environment risks are associated with children having a medical home.

Methods

Data from the nationally representative, cross-sectional 2011–2012 National Survey of Children’s Health telephone survey were used (N = 95,677). Analyses were conducted to describe the sample characteristics and determine the association between family and environmental risks and whether a child has a medical home. A subset of risks were modeled from the seminal study of ACEs.

Results

Nearly one-quarter of parents reported that their children experienced at-least one ACE. Compared to children who experienced no ACEs, children who experienced at least one ACE, or other family and environmental risks, had lower odds of having a medical home than those whom did not. Logistic regressions showed that cumulative ACEs (odds ratio (OR) 0.76; 95 % confidence interval (CI) 0.65–0.90) as well as other family and environmental risks (OR 0.36, 95 % CI 0.26–0.51) were related to lower odds of having a medical home.

Conclusions

This study suggests that family and environmental risks, including ACEs, impact parental report of a child having a medical home and that a dosage effect may exist. ACEs and other risk factors must be considered when providers care for children at-risk of experiencing negative events, particularly multiple negative events.

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Abbreviations

ACE:

Adverse childhood experiences

NSCH:

National Survey of Children’s Health

OR:

Odds ratio

PCMH:

Patient centered medical home

US:

United States

FPL:

Federal poverty level

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Conflict of interest

The authors have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University of Florida, PO Box 100265, Gainesville, FL, 32611, USA

    Jacqueline Baron-Lee

  2. PA Program, University of Florida, Gainesville, FL, USA

    Brandy Bonner

  3. Penn State University, University Park, PA, USA

    Caprice Knapp

  4. Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, USA

    Melissa Bright

  5. University of Central Florida, Orlando, FL, USA

    Melanie Hinojosa

Authors
  1. Jacqueline Baron-Lee
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  2. Brandy Bonner
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  3. Caprice Knapp
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  4. Melissa Bright
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  5. Melanie Hinojosa
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Corresponding author

Correspondence to Jacqueline Baron-Lee.

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Baron-Lee, J., Bonner, B., Knapp, C. et al. Factors Associated with Having a Medical Home for Children At-Risk of Experiencing Negative Events: Results from a National Study. Matern Child Health J 19, 2233–2242 (2015). https://doi.org/10.1007/s10995-015-1742-x

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  • DOI: https://doi.org/10.1007/s10995-015-1742-x

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