Survey Results

Survey Items: Survey instrument item number for children 0-5 years: C1, C8, C9, D1-D4, D7-D12; for children 6-11 years: C1, C8, C9, D1-D4, D7-D12; for children 12-17 years: C1, C9, C10, D1-D4, D7-D12
Variables in public use data file: S4Q01(2020); S4Q01(2021); K4Q01; K4Q02_R; K4Q04_R; K5Q10; K5Q11; K5Q40; K5Q41; K5Q42; K5Q43; K5Q44; K5Q20_R; K5Q21; K5Q22; K5Q30; K5Q31_R; K5Q32

Denominator: Children with special health care needs ages 0-17 years

Numerator: Care meets medical home criteria; Care does not meet medical home criteria

Revisions and Changes: Though there were changes to a few items which are used to score this measure since 2016, the overall concept of medical home and how it is measured in the survey did not change. For more information about the changes, click here.

Additional Notes: The American Academy of Pediatrics specifies seven qualities essential to medical home care: accessible, family-centered, continuous, comprehensive, coordinated, compassionate and culturally effective care. Ideally, medical home care is delivered within the context of a trusting and collaborative relationship between the child’s family and a competent health professional who is familiar with the child and family and the child’s health history. The presence of a medical home was measured by a composite measure based on five components constructed from a total of 16 survey items. These components are:
1. Personal doctor or nurse (Indicator 4.12a: PerDrNs_2021)
2. Usual source for sick care (Indicator 4.12b: UsualSck_2021)
3. Family-centered care (Indicator 4.12c: FamCent_2021)
4. Problems getting needed referrals (Indicator 4.12d: NoRefPrb_2021)
5. Effective Care Coordination when needed (Indicator 4.12e: CareCoor_2021)

To qualify as having a Medical Home, children must meet the criteria for adequate care on the first three components: personal doctor or nurse, usual source for care, and family-centered care. Additionally, any children who needed referrals or care coordination must also meet criteria for those components in order to qualify as having a medical home. Children with a valid, positive response to at least one component and the remainder of the components were missing or legitimately skipped are categorized as having a medical home. Further information about the Medical Home concept and measurement is available in the medical home manual developed by the CAHMI.
In 2021, the item S4Q01 asked respondents to include health care visits done by video or phone.

Treatment of Unknown Values: Missing values may be due to non-response (i.e. a skipped item) or a “don’t know” response. The way these items are handled can vary by measure. For NPMs and NOMs, having missing values for all items in an indicator will lead to the case being given a missing value on the overall measure. For some other measures, if there is a missing value on any of the items, the case will be set to missing. How missing values are handled is documented in the "Additional notes" field above when required.
Missing values are not included in the denominator when calculating prevalence estimates and weighted population counts displayed in the Interactive Data Query results table. In the majority of cases, the proportion of missing values is less than 2%. Exceptions are noted in the form of a Data Alert at the bottom of a results table. The exclusion of these values does not change the prevalence estimates (%) and only marginally affects the weighted population counts (Pop. Est.). To learn about the impact of the missing values on the population count estimates, click here.

History and Development:
Overview of the Title V Block Grant
The Title V Maternal and Child Health (MCH) Services Block Grant Program is a federal-state partnership to improve the health and well-being of mothers, children (including children with special health care needs) and their families in all 59 states and jurisdictions. The Title V MCH Block Grant Performance Measure Framework enables states to demonstrate the impacts of Title V within a state. The performance measurement system utilizes national data sources, including the NSCH, to track the ultimate outcomes of the program -- National Outcome Measures (NOMs) – and the key metrics of health behavior or health care access and quality -- National Performance Measures (NPMs) -- that influence NOMs. For more information on NPM and NOM content changes, click here. More information about the Title V MCH Block Grant and performance measurement system can be obtained at the MCHB website.
About NSCH
The National Survey of Children’s Health (NSCH), funded and directed by the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB), is designed to provide annual national and state-level information on the health and well-being of children ages 0-17 years in the United States. The U.S. Census Bureau administers the survey, oversees the sampling, and produces a final data set of survey results. HRSA’s Maternal and Child Health Bureau (MCHB) develops survey content in collaboration with the U.S. Census Bureau and a Technical Expert Panel. The Technical Expert Panel consists of experts in survey methodology and children’s health, federal and state stakeholders, clinicians and researchers. In 2016, the NSCH underwent a significant redesign which combined content from both the NSCH and the National Survey of Children with Special Health Care Needs (NS-CSHCN). Further information on that redesign can be found in “The Design and Implementation of the 2016 National Survey of Children’s Health”.
The NSCH is conducted as a household survey, and one child per household is selected to be the subject for the detailed age-specific questionnaire. The respondent to this questionnaire is a parent or guardian who is living in the home and has knowledge of the sampled child. Survey participants complete either web-based or self-administered paper-and-pencil questionnaires. Data from the NSCH is used for scientific research, federal policy and program development, and state-level planning and performance reporting. Information is collected on factors related to the health and well-being of children, including access to and utilization of health care, receipt of care in a medical home, systems of care for CSHCN, family interactions, parental health, school and after-school experiences, and neighborhood characteristics. More information about the survey can be found in the “About the National Survey of Children's Health” section of this website and HRSA’s MCHB website.