Relationship between health care transition preparation and future medical home for youth with special health care needs

Health care transition preparation is intended to decrease disruptions in medical care and health insurance and prepare for the adult health care system as children/youth with special health care needs (CSHCN) mature. Discussions and planning with a medical professional has been identified as an essential feature of successful transition. The Maternal and Child Health Bureau (MCHB) identifies transition support and medical home as core performance outcomes for CSHCN. This study examines the association of transition experiences with health care access in young adulthood. The 2007 SLAITS follow-back Survey of Adult Transition and Health (SATH) interviewed 1,865 young adults ages 19-23 from a sample of adolescent CSHCN whose parents were interviewed in the 2001 National Survey of Children with Special Health Care Needs (NS-CSHCN). Respondents were asked if they had discussed future needs for an adult doctor, discussed how to obtain/keep health insurance, and if they ever participated in developing a transition plan. The dependent variable of medical home was defined as having a usual source of care, a personal doctor or nurse and professional assistance coordinating care. The study used bivariate and multiple logistic regression models that accounted for covariates including demographic variables. The analysis was stratified by whether or not the young adult reported a current special health care need. Overall, 31% of young adults reported a special health care need, 72% had a personal doctor and a usual source of care, and 40% had help coordinating their care. In bivariate analysis, discussion during adolescence about changing healthcare needs was significantly associated with having a personal doctor for those with (OR=2.30; 95% CI= 1.06-5.02) and without (OR=2.38; 95% CI=1.63-3.48) a special health care need. Discussions were significantly associated with having a usual source of care for those without a SHCN (OR=2.42; 95% CI=1.65-3.55) but not for those with a SCHN. When controlling for covariates, discussions about changing healthcare needs was still significantly associated with having a personal doctor for those without a SHCN (OR= 2.23; 95% CI=1.15-4.37), but not for those with. Therefore, discussions and planning for changing health care needs as a youth may predict having aspects of a medical home as a young adult for the general population. However, current transition support is not sufficient to ensure that all young adults with special needs have a medical home, which may be due to insufficiently intensive support and barriers once adolescents become young adults.