Academic Pediatrics
Volume 10, Issue 1 , Pages 56-63, January 2010

Comparing Medical Homes for Children with ADHD and Asthma

  • Sara L. Toomey, MD, MPH, MPhil, MSc

      Affiliations

    • Corresponding Author InformationAddress correspondence to Sara L. Toomey, MD, MPH, MPhil, MSc, Division of General Pediatrics, Children's Hospital Boston, Harvard Medical School, 21 Autumn Street, 2nd Floor, Boston, Massachusetts 02215.
    • ,
  • Charles J. Homer, MD, MPH
    • ,
  • Jonathan A. Finkelstein, MD, MPH

Division of General Pediatrics, Children's Hospital Boston, Harvard Medical School, Boston, Mass (Dr Toomey); Department of Population Medicine, Harvard Pilgrim Health Care Institute, and Harvard Medical School, Boston, Mass (Dr Toomey and Dr Finkelstein); and National Initiative for Children's Healthcare Quality, Cambridge, Mass (Dr Homer)

Received 13 April 2009; accepted 2 November 2009.

Objective

The aims of our study were, among children with attention-deficit/hyperactivity disorder (ADHD) compared with children with asthma: 1) to assess characteristics associated with parent report of having a medical home for children with either of these 2 conditions; 2) to determine whether, controlling for these characteristics, the likelihood of having a medical home differs between children with ADHD and asthma; and 3) to identify the specific components of a medical home that are lacking for children with these 2 conditions.

Methods

Cross-sectional analysis of the National Survey of Children with Special Health Care Needs, 2005–2006 (NS-CSHCN) was used. The outcome variable was parent report of their child's practice having specific attributes of the medical home. We used multivariate logistic regression to test whether the likelihood of having a medical home and its components differed for children with ADHD in comparison to children with asthma.

Results

The NS-CSHCN interviewed parents of 11 674 children with ADHD and 13 517 children with asthma aged between 4 to 17 years. Significantly fewer children with ADHD compared with children with asthma have a medical home (OR [odds ratio] 0.68; P < .001). Specifically, parents reported differences in receiving family-centered (OR 0.79; P < .001) and coordinated care (OR 0.59; P < .001).

Conclusion

Parents of children with ADHD report worse performance across key dimensions of primary care compared with parents of children with asthma. For primary care to be optimally effective in addressing the needs of children with ADHD, efforts to significantly strengthen these key dimensions are needed.

Key Words: ADHD, medical home, primary care

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PII: S1876-2859(09)00300-3

doi:10.1016/j.acap.2009.11.001

Academic Pediatrics
Volume 10, Issue 1 , Pages 56-63, January 2010

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