Care coordination, the family-centered medical home, and functional disability among children with special health care needs
Abstract
Background Children with special health care needs (CSHCN) are at increased risk for functional disabilities. Care coordination has been shown to decrease unmet health service use but has yet been shown to improve functional status. We hypothesize that care coordination services lower the odds of functional disability for CSHCN and that this effect is greater within the context of a family-centered medical home. A secondary objective was to test the mediating effect of unmet care needs on functional disability.Methods Our sample included children ages 0 to 17 years participating the 2009-2010 National Survey of Children with Special Health Care Needs. Care coordination, unmet needs, and disability were measured by parent report. We used logistic regression models with covariate adjustment for confounding and a mediation analysis approach for binary outcomes to assess the effect of unmet needs.Results There were 34,459 children in our sample. Care coordination was associated with lower odds of having a functional disability (adjusted odds ratio 0.82, 95% confidence interval 0.77, 0.88). This effect was greater for care coordination in the context of a medical home (adjusted odds ratio 0.71, 95% confidence interval 0.66, 0.76). The relationship between care coordination and functional disability was mediated by reducing unmet services.Conclusions Care coordination is associated with lower odds of functional disability among CSHCN, especially when delivered in the setting of a family-centered medical home. Reducing unmet service needs mediates this effect. Our findings support a central role for coordination services in improving outcomes for vulnerable children.
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- Authors
- Litt, J. S., & McCormick, M. C.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- Corresponding author
- Litt, Jonathan S.
- Venue
- Academic Pediatrics
- Publisher
- Elsevier BV
- Published
- 2015-03
- Volume
- 15
- Issue
- 2
- Pages
- 185-190
- ISSN
- 1876-2859 (ISSN-L)
- OpenAlex
- W2111342278
- Cited by
- 59
- References
- 22
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 5 · 2022: 7 · 2021: 4 · 2020: 8 · 2019: 6 · 2018: 12 · 2017: 2 · 2016: 7 · 2015: 4
- FWCI
- 9.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Academic Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Public Health Service (T76-MC-00001)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (1 L40 HD070218-01)
- Topics
- Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
- Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- care coordination, functional disability, children with special health care needs, unmet care needs, mediation analysis, pediatric primary care, health care utilization
- MeSH terms
- Adolescent, Child, Child Health Services, Child, Preschool, Continuity of Patient Care, Female, Health Services Needs and Demand, Humans, Infant, Infant, Newborn, Male, Odds Ratio, Patient-Centered Care, Children with Disabilities, Needs Assessment
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