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Racial and Ethnic Disparities in Indicators of a Primary Care Medical Home for Children

  • Jean L. Raphael
    Correspondence
    Address correspondence to Jean L. Raphael, MD, MPH, Clinical Care Center, Suite D.1540.00, Texas Children's Hospital, 6621 Fannin Street, Houston, Texas 77030.
    Affiliations
    Department of Pediatrics, Baylor College of Medicine, Houston, Tex (Dr Raphael and Dr Giardino); Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Tex (Dr Guadagnolo); and Commonwealth Fund, New York, NY (Dr Beal)
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  • B. Ashleigh Guadagnolo
    Affiliations
    Department of Pediatrics, Baylor College of Medicine, Houston, Tex (Dr Raphael and Dr Giardino); Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Tex (Dr Guadagnolo); and Commonwealth Fund, New York, NY (Dr Beal)
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  • Anne C. Beal
    Affiliations
    Department of Pediatrics, Baylor College of Medicine, Houston, Tex (Dr Raphael and Dr Giardino); Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Tex (Dr Guadagnolo); and Commonwealth Fund, New York, NY (Dr Beal)
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  • Angelo P. Giardino
    Affiliations
    Department of Pediatrics, Baylor College of Medicine, Houston, Tex (Dr Raphael and Dr Giardino); Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Tex (Dr Guadagnolo); and Commonwealth Fund, New York, NY (Dr Beal)
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      Objective

      Racial/ethnic disparities in access to care across a broad range of health services have been well established. In adults, having a medical home has been shown to reduce disparities. The objective of this study was to assess the extent to which children of different race/ethnicities receive primary care consistent with a medical home.

      Methods

      We conducted a secondary analysis of 84 101 children, ages 0–17, from the 2003–2004 National Survey of Children's Health, a nationwide household survey. The primary independent variable was race/ethnicity of the child. The main dependent variable was a medical home as defined by the American Academy of Pediatrics. Multiple logistic regression was conducted to investigate associations between race/ethnicity and having a medical home.

      Results

      The odds of having a medical home were lower for non-Hispanic black (odds ratio [OR] 0.76, 95% confidence interval [95% CI] 0.69–0.83), Hispanic (OR 0.80, 95% CI 0.72–0.89), and other (OR 0.77, 95% CI 0.69–0.87) children compared with non-Hispanic white children after adjusting for sociodemographic variables. Specific components of a medical home for which minority children had a lower odds (P < .01) of having compared with white children included having a personal provider, a provider who always/usually spent enough time with them, and a provider who always/usually communicated well.

      Conclusions

      Minority children experienced multiple disparities compared with white children in having a medical home. Study of individual medical home components has the potential to identify specific areas to improve disparities.

      Key Words

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      References

        • Institute of Medicine
        Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.
        National Academies Press, Washington, DC2003
        • Flores G.
        • Tomany-Korman S.C.
        Racial and ethnic disparities in medical and dental health, access to care, and use of services in US children.
        Pediatrics. 2008; 121: e286-e298
        • Shi L.
        • Stevens G.D.
        Disparities in access to care and satisfaction among US children: the roles of race/ethnicity and poverty status.
        Public Health Rep. 2005; 120: 431-441
        • Malat J.
        • Oh H.J.
        • Hamilton M.A.
        Poverty experience, race, and child health.
        Public Health Rep. 2005; 120: 442-447
        • Flores G.
        • Fuentes-Afflick E.
        • Barbot O.
        • et al.
        The health of Latino children: urgent priorities, unanswered questions, and a research agenda.
        JAMA. 2002; 288: 82-90
        • Hambidge S.J.
        • Emsermann C.B.
        • Federico S.
        • Steiner J.F.
        Disparities in pediatric preventive care in the United States, 1993–2002.
        Arch Pediatr Adolesc Med. 2007; 161: 30-36
        • Flores G.
        • Olson L.
        • Tomany-Korman S.C.
        Racial and ethnic disparities in early childhood health and health care.
        Pediatrics. 2005; 115: e183-e193
      1. Healthy People 2010: Understanding and Improving Health.
        2nd ed. US Government Printing Office, Washington, DC2002
        • Ortega A.N.
        • Stewart D.C.
        • Dowshen S.A.
        • Katz S.H.
        The impact of a pediatric medical home on immunization coverage.
        Clin Pediatr (Phila). 2000; 39: 89-96
      2. Center for Medical Home Improvement. Building a medical home: improvement strategies in primary care for children with special health care needs. Available at: http://www.medicalhomeimprovement.org. Accessed February 19, 2009.

      3. Medical Home Initiatives for Children with Special Needs Project Advisory Committee. American Academy of Pediatrics. The medical home.
        Pediatrics. 2002; 110: 184-186
        • Starfield B.
        • Shi L.
        Policy relevant determinants of health: an international perspective.
        Health Policy. 2002; 60: 201-218
        • Starfield B.
        • Shi L.
        The medical home, access to care, and insurance: a review of evidence.
        Pediatrics. 2004; 113: 1493-1498
      4. Federal Interagency Forum on Child and Family Statistics. America's Children: Key National Indicators of Well-Being 2007.
        US Government Printing Office, Washington, DC2007
        • Homer C.J.
        • Klatka K.
        • Romm D.
        • et al.
        A review of the evidence for the medical home for children with special health care needs.
        Pediatrics. 2008; 122: e922-e937
        • Beal A.C.
        • Doty M.M.
        • Hernandez S.E.
        • et al.
        Closing the Divide: How Medical Homes Promote Equitable Care: Results from the Commonwealth Fund 2006 Health Quality Survey.
        New York, NY: Commonwealth Fund;. 2007;
        • Adams K.
        • Corrigan J.
        Priority Areas for National Action: Transforming Health Care Quality.
        National Academies Press, Washington, DC2003
        • McGlynn E.A.
        Introduction and overview of the conceptual framework for a national quality measurement and reporting system.
        Med Care. 2003; 41: I1-I7
        • Institutes of Medicine
        Crossing the Quality Chasm: A New Health System for the 21st Century.
        National Academies Press, Washington, DC2001
        • Palfrey J.S.
        • Sofis L.A.
        • Davidson E.J.
        • et al.
        The Pediatric Alliance for Coordinated Care: evaluation of a medical home model.
        Pediatrics. 2004; 113: 1507-1516
        • Blumberg S.
        • Olson L.
        • Srinath K.
        • Giambo P.
        Design and operation of the national survey of children's health.
        Vital Health Stat. 2005; 43: 1-124
      5. Bethell C, Read D. Evaluation of Medical Home Measurement for Children for the National Survey of Children's Health. Hyattsville, Md: National Center for Health Statistics; 2003.

        • Bethell C.
        • Read D.
        Evaluation of Medical Home Measurement in the National Survey of Children's Health 2003. The Child and Adolescent Health Measurement Initiative Report to the National Center for Health Statistics.
        Centers for Disease Control and Prevention, Atlanta, Ga2003
      6. Bethell C, Read D. Measuring Medical Home: Using Data Elements from the National Survey of Children With Special Health Care Needs or National Survey of Children's Health. Portland, Ore: Child and Adolescent Health Measurement Initiative; 2008.

        • Bethell C.D.
        • Read D.
        • Stein R.E.
        • et al.
        Identifying children with special health care needs: development and evaluation of a short screening instrument.
        Ambul Pediatr. 2002; 2: 38-48
        • Mulvihill B.A.
        • Altarac M.
        • Swaminathan S.
        • et al.
        Does access to a medical home differ according to child and family characteristics, including special-health-care-needs status, among children in Alabama?.
        Pediatrics. 2007; 119: S107-S113
        • Shone L.P.
        • Dick A.W.
        • Brach C.
        • et al.
        The role of race and ethnicity in the State Children's Health Insurance Program (SCHIP) in four states: are there baseline disparities, and what do they mean for SCHIP?.
        Pediatrics. 2003; 112: e521
        • McAllister J.W.
        • Presler E.
        • Cooley W.C.
        Practice-based care coordination: a medical home essential.
        Pediatrics. 2007; 120: e723-e733
        • Nolan T.
        • Berwick D.M.
        All-or-none measurement raises the bar on performance.
        JAMA. 2006; 295: 1168-1170
        • Bethell C.D.
        • Read D.
        • Brockwood K.
        Using existing population-based data sets to measure the American Academy of Pediatrics definition of medical home for all children and children with special health care needs.
        Pediatrics. 2004; 113: 1529-1537
      7. Joint principles of a patient-centered medical home released by organizations representing more than 300,000 physicians. Available at: http://www.aafp.org/online/en/home/media/releases/2007/20070305pressrelease0.html. Accessed February 19, 2009.

        • Berenson R.A.
        • Hammons T.
        • Gans D.N.
        • et al.
        A house is not a home: keeping patients at the center of practice redesign.
        Health Aff. 2008; 27: 1219-1230
        • Fisher E.S.
        Building a medical neighborhood for the medical home.
        N Engl J Med. 2008; 359: 1202-1205
        • Iglehart J.K.
        No place like home—testing a new model of care delivery.
        N Engl J Med. 2008; 359: 1200-1202
        • Basu J.
        • Clancy C.
        Racial disparity, primary care, and specialty referral.
        Health Serv Res. 2001; 36: 64-77