Does access to a medical home reduce the family impact of autism spectrum disorder? A national study of children with special health care needs, 2005-2006

The medical home has emerged as a model of comprehensive, coordinated, family-centered health care for children. Having a medical home has been associated with reduced unmet health care needs and improved subspecialty care. However, whether having a medical home is associated with less family impact from having a child with a complex condition such as autism spectrum disorder (ASD) has not been examined. Children with ASD often have multiple concurrent disorders requiring a broad range of services. We used the 2005-2006 National Survey of Children with Special Health Care Needs (CSHCN) to compare 2,088 CSHCN, ages 3-17, reported to have ASD with other CSHCN on five measures of family impact related to the child's health care (financial problems; needing additional income; reducing/stopping work; spending 10+ hours per week on care; and paying > $1000 for medical care). Using logistic regression, we examined each family impact measure in relation to the joint association between ASD and presence of a medical home, after adjusting for sociodemographic factors, insurance type, and severity of child's health condition. Relative to CSHCN without ASD, CSHCN with ASD were less likely to have a medical home (48% vs. 26.5%). CSCHN with ASD and no medical home had significantly greater family impact compared to CSHCN with ASD who had a medical home. Moreover, the impact of ASD (i.e., the difference between CSHCN with ASD and CSHCN without ASD) is smaller when CSHCN have a medical home. Medical homes appear to have the potential to improve the lives of families of children with ASD.