| The purpose of this study was to examine the influence of having access to a medical home on the use of the emergency department, primary care office visits and the number of missed school days among children with special health care needs.;Analysis of 40,723 children, aged 0--18, from the 2005--2006 National Survey of Children with Special Health Care Needs (CSHCN) was conducted. Descriptive statistics characterize CSHCN and elements of medical home. Separate ordinal regression models were used to calculate the associations between presence of medical home, ED visits and missed school. Primary care office visits were examined using multivariate regression. The covariates were chosen using previous literature and Andersen's Behavioral Model of Health Services Use, and included, gender, age, race, ethnicity, education, functional limitation, poverty, metropolitan statistical area of residence, and insurance.;The association between medical home and emergency department (ED) visits was not statistically significant. Females, Non-Hispanic Black, CSHCN living in rural areas, and those with moderate or severe functional limitations made the greatest ED visits. Medical home was associated with more primary care office visits for CSHCN (AOR 1.60; 95% CI 1.47--1.75). Non-Hispanic Blacks and uninsured CSHCN had fewer office visits. The presence of a medical home among CSHCN was associated with eight or more missed school days (AOR 2.46; 95% CI 1.46--3.16).;The implications of this study may serve to point out that the services included in the current model of medical home are not serving those children with special needs who are most vulnerable in the areas of fragmented care. |
