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National Survey of Children's Health

Allison E. Brachlow, MD; Kirsten K. Ness, PhD; Melissa L. McPheeters, PhD, MPH; James G. Gurney, PhD

Arch Pediatr Adolesc Med. 2007;161(4):399-405.

Objective  To assess the extent to which parents of children with autism compared with parents of children with asthma or other special health care needs report receiving primary care for their child consistent with the American Academy of Pediatrics medical home model.

Design  Population-based cross-sectional study.

Setting  National Survey for Children's Health 2003-2004 telephone interview.

Participants  Parents of 495 children with autism, parents of 6716 children with asthma, and parents of 11 403 children with other special health care needs without asthma.

Main Exposures  Autism and other special health care needs including asthma.

Main Outcome Measures  Medical home score and components of care, as follows: personal provider and preventive; family-centered, compassionate, and culturally appropriate; accessible; comprehensive; and coordinated.

Results  The odds of parents reporting care consistent with that in a medical home were less likely for children with autism (odds ratio, 0.45; 95% confidence interval, 0.30-0.66) and more likely for children with asthma (odds ratio, 1.17; 95% confidence interval, 1.06-1.30) compared with children with other special health care needs (1 [reference]). These differences persisted even after controlling for condition severity, personal characteristics, and insurance status. Specific components of a medical home less prevalent among children with autism than among children with other special health care needs included family-centered, comprehensive, and coordinated care.

Conclusion  Although we could not evaluate the reasons why, a large percentage of children with autism do not receive primary care consistent with that in a medical home.

Author Affiliations: Department of Pediatrics, University of Minnesota, Minneapolis (Dr Brachlow); Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tenn (Dr Ness); and Department of Pediatrics, University of Michigan, Ann Arbor (Drs McPheeters and Gurney).

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