Family-Centered Care Measurement and Associations With Unmet Health Care Need Among US Children Olivia J. Lindly, MPH; G. John Geldhof, PhD; Alan C. Acock, PhD; Kari-Lyn K. Sakuma, PhD, MPH; Katharine E. Zuckerman, MD, MPH; Sheryl Thorburn, PhD, MPH From the School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Ore (Ms Lindly and Drs Geldhof, Acock, Sakuma, and Thorburn); and Divison of General Pediatrics, Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, Ore (Ms Lindly and Dr Zuckerman) Conflict of Interest: The authors declare that they have no conflict of interest. Address correspondence to Olivia Lindly, MPH, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 410 Waldo Hall, 2250 SW Jefferson Way, Corvallis, OR 97331 (e-mail: lindlyo@oregonstate.edu). Received for publication June 20, 2016; accepted October 28, 2016. ABSTRACT OBJECTIVE: Family-centered care (FCC), including shared decision making (SDM), has become increasingly emphasized in pediatric health care delivery. Past studies using national surveys have used different FCC measurement approaches without determining their validity. We, therefore, sought to develop an FCC measurement model with Medical Expenditure Panel Survey (MEPS) items previously used to assess FCC or SDM; and to determine temporal associations of FCC with unmet health care need. METHODS: Four longitudinal MEPS data files (2007–2011) were combined. The study sample included 15,764 US children aged 0 to 17 years. Eight items assessed FCC, and 5 items assessed unmet health care need. We performed exploratory factor analyses to develop an FCC measurement model and fit a cross-lagged structural equation model to determine temporal associations between FCC and unmet health care need. RESULTS: Results supported a 2-factor FCC model including family–provider communication and SDM. The family– provider communication factor was indicated by items reflecting general communication between the child’s doctor and family. The SDM factor was indicated by items reflecting decision-making about the child’s health care. Adjusted cross- lagged structural equation model results showed family– provider communication and SDM were associated with a reduced likelihood of unmet health care need the following year. Unmet health care need was not significantly associated with family–provider communication or SDM the subsequent year. CONCLUSIONS: Study results support differentiating between family–provider communication and SDM as interrelated aspects of FCC in future pediatric health care quality measure- ment and improvement. Family–provider communication and SDM may reduce the likelihood of unmet health care need the following year among US children. KEYWORDS: family-centered care; pediatric health care quality measurement; shared decision making; structural equation modeling; unmet health care need ACADEMIC PEDIATRICS 2016;-:1–9 WHAT’S NEW Seven Medical Expenditure Panel Survey items were used to validly assess family-centered care, including family–provider communication and shared decision making (SDM). Family–provider communication and SDM were associated with a lower likelihood of unmet health care need the following year among US children. F AMILY -CENTERED CARE (FCC) is an integral compo- nent of pediatric health care quality in the United States, as emphasized by federal health care legislation 1,2 and population health priorities. 3,4 FCC may be associated with positive health care experiences, 5 increased parent knowledge of health-promoting behaviors for children, 6 reduced unmet health care needs, 6,7 reduced acute care, 8,9 increased preventive care utilization, 7,9 and reduced out-of-pocket 7 and inpatient medical expendi- tures. 10 Yet FCC evidence remains limited as a result of inconsistent measurement approaches and a lack of hetero- geneity in the populations studied. 11–13 Determining and utilizing valid measures of FCC may help strengthen its evidence base while better enabling health systems to deliver quality care to children. The Committee on Hospital Care and Institute for Patient- and Family-Centered Care defines FCC as an “innovative approach to pediatric health care planning, delivery, and evaluation that is grounded in a mutually beneficial partnership among patients, families, and pro- viders that recognizes the importance of the family in the patient’s life.” 14 Key FCC principles include information sharing, respect and honoring differences, partnership ACADEMIC PEDIATRICS Copyright ª 2016 by Academic Pediatric Association 1 Volume -, Number - -–- 2016