HAVING A PARTICULAR CLINICIAN FOR WELL CHILD CARE AND QUALITY OF EARLY CHILDHOOD HEALTH CARE Moira Inkelas, Mark A. Schuster, Paul W. Newacheck, Lynn M. Olson, Neal Halfon Public Health, UCLA, Los Angeles, CA; Pediatrics, UCLA, Los Angeles, CA; Rand, Santa Monica, CA; Institute for Policy Studies, UCSF, San Francisco, CA; American Academy of Pediatrics, Elk Grove Village, IL

BACKGROUND: Having a usual provider is an important component of the "medical home," a model of primary care that incorporates several features: continuity, coordination, and comprehensiveness. Studies show that adult patients value having a particular primary care clinician and that having such a clinician is associated with better continuity of care. For well child care and health supervision, having a particular clinician and a regular location of care may promote continuity and family-centered care.

OBJECTIVE: To determine what percentage of young children have a particular clinician for well child care, variations by setting, and association with satisfaction.

DESIGN/METHODS: The National Survey of Early Childhood Health (NSECH) is a telephone survey of 2,068 parents of children 4 to 35 months old that profiles content and quality of health care for young children. Logistic regression and OLS models show the relationship between having a particular clinician and ratings of preventive care.

RESULTS: Nearly all young children have a regular location for well child care, but only 46% have a particular clinician. In a multivariate logistic regression model, children who are publicly insured (OR 0.5, CI 0.4-0.8), uninsured (OR 0.4, CI 0.2-0.8), or in a private group practice (0.7, CI 0.5-0.9) are less likely to have a particular clinician, as are children in a health plan with gatekeeping requirements (OR 1.4, CI 1.0-1.9). In multivariate OLS, controlling for factors including health status, race, maternal education, and health care setting, the FACCT measure of family centered care is higher for children who have a particular clinician. Comprehensiveness of health supervision content is higher for children with a particular clinician. However, content is not associated with having a particular clinician, when controlling for child?s site of care and other factors.

CONCLUSIONS: Just under half of young children 4 to 35 months old have a particular clinician for well child care. Although in multivariate analysis, having a particular clinician is not associated with overall health supervision content, parents of children with one clinician report higher family centered care across health care settings.