Elsevier

Academic Pediatrics

Volume 9, Issue 4, July–August 2009, Pages 221-227
Academic Pediatrics

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

https://doi.org/10.1016/j.acap.2009.01.011Get rights and content

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.

Section snippets

Survey Design and Participants

Data for this study were drawn from the 2003 National Survey of Children's Health (NSCH), a telephone survey sponsored by the Maternal and Child Health Bureau (MCHB).21 The purpose of the NSCH was to assess health indicators in children ages 0 to 17 years of age and to measure their experiences in the health care system. The NSCH used the State and Local Area Integrated Telephone Survey program, an ongoing surveillance initiative available for tracking and monitoring the health and well-being

Patient Demographics

Sociodemographic characteristics of our sample were analyzed according to race/ethnicity. White children had the highest proportion (69%) of individuals reported as having excellent health compared with black (52%), Hispanic (41%), and other (62%) children (P < .0001). Hispanic children had the highest percentage of families with income levels less than 100% of the federal poverty level (35%) and parental education less than high school (29%). Hispanic children had the lowest proportion of

Discussion

The findings from this nationally representative study document that minority children experienced multiple disparities in having a medical home. Previous studies have demonstrated racial/ethnic disparities in access to numerous aspects of pediatric preventive care, including significant differences in screening during primary care visits, parents feeling understood by providers, parental satisfaction, and referrals to specialists.2, 6, 7 In our study, compared with white children, minority

Acknowledgments

The authors have no conflicts of interest or financial affiliations to disclose.

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