National Disparities in the Quality of a Medical Home for Children

Authors, Primary Stevens,G. D.;Seid,M.;Pickering,T. A.;Tsai,K. Y.
Title Primary National Disparities in the Quality of a Medical Home for Children
Periodical Full Maternal and Child Health Journal
Pub Year 2010
Volume 14
issue 4
Start Page 580-589
Abstract OBJECTIVES: To examine socio-demographic disparities associated with a quality medical home. METHODS: A nationally representative sample of children ages 0-17 years (n = 102,353) from the 2003 National Survey of Children's Health. Risk factors including non-white race/ethnicity, income <200% of the federal poverty level (FPL), uninsured, parent education lesser than high school, and non-English primary household language, were examined in relation to a quality medical home separately and together as a "profile" of risk. Fourteen questions were used to measure five medical home features: access, continuity, comprehensiveness, family-centered care, and coordination. Quality was defined as a value greater than median for each feature and for an overall score. RESULTS: Before and after adjustment for child demographics and health status, all studied risk factors were associated with poorer quality medical home features. Uninsured [odds ratio (OR) = 0.43, 95% confidence interval (CI): 0.40-0.47] and low-income children (OR = 0.65, CI: 0.62-0.69) had among the lowest odds of a quality medical home overall and across most features, except coordination that showed an opposite trend. Summarized through risk profiles, children experiencing all five risk factors had 93% lower odds of a quality medical home overall (OR = 0.07, CI: 0.04-0.25) compared to zero risk children. CONCLUSION: This study demonstrates large national disparities in the quality of a medical home for children. That disparities were most prevalent for the uninsured and those in or near poverty, both modifiable risk factors, suggests that reforms to increase coverage and to lift families out of poverty are essential to assuring that children have access to the full complement of appropriate health care services including a quality medical home.
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Author/Address Affiliation: Keck School of Medicine, University of Southern California, 1000 South Fremont Ave, Unit #80, Alhambra, 91803, United States; Affiliation: Division of Pulmonary Medicine and Center for Health Care Quality, Division of Health Policy )
PubMed Link
Reference Type(s) Journal Article
Topic Tag(s) Defining/Evaluating/Qualifying a Medical Home;Disparities
Special Population(s) Children with Special Needs;Children without Special Needs
Case Study No
Commentary/Opinion Piece No
Historical Publication No
Key/Foundational Article No
Literature Review No
Article Rating No
Summary of Article Rating No