Medical Home Access Among American Indian and Alaska Native Children in 7 States: National Survey of Children’s Health

To describe the prevalence of medical home among American Indian and Alaska Native children (AIAN) compared to non-Hispanic
white (NHW) children and identify areas for improvement in the provision of care within a medical home. Prevalence of medical
home, defined as family-centered, comprehensive, coordinated, compassionate, culturally effective care, including a personal
doctor or nurse and usual care location, was estimated using 2007 National Survey of Children’s Health data. Analyses included
1–17 year-olds in states reporting AIAN race as a distinct category (Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma,
and South Dakota, n = 9,764). Associations between medical home and demographic (child’s age, household education and income, and state) and
health-related [child’s insurance status, special health care need status, and past year Indian Health Service (IHS) utilization]
characteristics were assessed among AIAN children. Overall, the prevalence of medical home was 27 % lower among AIAN children
(42.6, 95 % CI = 34.4–50.8) than NHW children (58.3, 95 % CI = 56.2–60.4). Child’s age (adjusted OR [aOR] = 2.7, 95 % CI = 1.3–5.6)
was significantly associated with medical home. IHS utilization was associated with medical home among AIAN children with
private insurance (aOR = 0.2, 95 % CI = 0.1–0.4), but not among uninsured or publicly insured children. Care coordination
and family-centered care were noted areas for improvement among AIAN children. Less than half of AIAN children had a medical
home. Future studies should further examine the intersection between insurance and IHS to determine if enhanced coordination
is needed for this population, which is often served by multiple federally-funded health-related programs.