Healthcare Quality Experiences of Children and Youth with Mobility Limitations

Background: Nationwide, 10 - 15% of children with special health care needs (CSHCN) are reported to have significant mobility limitations, usually with co-morbidities and complex needs. Although care in a “medical home” is plausibly beneficial, there is no population-based evidence for whether this primary care model improves their healthcare experiences. Methods: This cross-sectional analysis examined associations between parent-reported mobility limitations, having a medical home, and quality experiences of children, ages 4 – 17 years, in the 2005/2006 National Survey CSHCN (n = 40,387). Mobility limitations were defined by functional restrictions. Healthcare quality was measured with indicators of reported difficulties getting care in several domains and low overall healthcare satisfaction. Five criteria described care in a medical home. Associations were tested with survey-weighted logistic regression, controlling for important covariates (e.g. age, race/ethnicity, insurance, condition severity and SES). Results: Parents of children with mobility limitations reported lower satisfaction with care (OR = 1.60; 95% CI: 1.42, 1.81), and more problems with service availability (OR = 1.80; 95% CI; 1.40, 2.28) and other outcomes than did parents of other CSHCN. Adding indicators of the medical home to the statistical models attenuated odds ratios for mobility limitations but the estimates remained significant. In models restricted to children with mobility limitations, having a medical home was strongly associated with improved quality and satisfaction. Conclusions: Having a medical home appears to improve healthcare quality experiences of children with mobility limitations but may be insufficient to eliminate the quality disparities they experience relative to other CSHCN.