Gaps and Factors Related to Receipt of Care within a Medical Home for Toddlers Born Preterm - 20/12/18
, Mary Ann Nelin, MD 2, 3, Deena J. Chisolm, PhD 4, 5, 6, Sarah A. Keim, PhD, MA, MS 5, 7, 8Abstract |
Objective |
To characterize gaps and factors related to receipt of care within a medical home for toddlers born preterm.
Study design |
Participants were 202 caregivers of children born at <35 weeks of gestation. At 10-16 months of corrected age, caregivers completed the National Survey of Children's Health (2011/2012) medical home module and a sociodemographic profile. Care within a medical home comprised having a personal doctor/nurse, a usual place for care, effective care coordination, family-centered care, and getting referrals when needed. Gestational age and neonatal follow-up clinic attendance were abstracted from the medical record. The Bayley Scales of Infant and Toddler Development, Third Edition assessed developmental status. Log-binomial regression examined factors related to receiving care within a medical home.
Results |
Fifty-three percent (n = 107) of the children received care within a medical home. Low socioeconomic status (young caregiver: risk ratio [RR] = 0.73; 95% CI 0.55, 0.97; low education: RR= 0.69; 95% CI 0.49, 0.98) and delayed language (RR = 0.63; 95% CI 0.42, 0.95) were associated with a lower likelihood of receiving care within a medical home. Degree of prematurity and neonatal clinic follow-up participation were unrelated to receipt of care within a medical home.
Conclusions |
Receipt of care within a medical home was lacking for nearly one-half of preterm toddlers, especially those with lower socioeconomic status and poorer developmental status. Discharge from a neonatal intensive care unit may be an optimal time to facilitate access to a primary care medical home and establish continuity of care.
Trial registration |
ClinicalTrials.gov: NCT01576783.
Le texte complet de cet article est disponible en PDF.Keywords : medical home, prematurity, toddlerhood, children with special healthcare needs
Abbreviations : Bayley-III, CSHCN, NICU, NSCH, SES
Plan
| Supported by grant R40MC28316 from the US Health Resources and Services Administration Maternal and Child Health Field–initiated Innovative Research Studies Program, grant 12-FY14-171 from the March of Dimes, a grant from the Allen Foundation, a grant from Cures Within Reach, grant UL1TR001070 from the National Center for Advancing Translational Sciences/National Institutes of Health, and internal support from The Research Institute at Nationwide Children's Hospital. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government, or the other study supporters. The authors declare no conflicts of interest. |
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?