| National disparities in the quality of a medical home for children. | |
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MedLine Citation:
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PMID: 19214723 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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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Authors:
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Gregory D Stevens; Michael Seid; Trevor A Pickering; Kai-Ya Tsai |
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Publication Detail:
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Type: Journal Article; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Maternal and child health journal Volume: 14 ISSN: 1573-6628 ISO Abbreviation: Matern Child Health J Publication Date: 2010 Jul |
Date Detail:
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Created Date: 2010-07-02 Completed Date: 2010-11-02 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9715672 Medline TA: Matern Child Health J Country: United States |
Other Details:
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Languages: eng Pagination: 580-9 Citation Subset: IM |
Affiliation:
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Keck School of Medicine, University of Southern California, 1000 South Fremont Ave, Unit #80, Alhambra, CA 91803, USA. gstevens@usc.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Child Child Health Services / economics, standards* Child, Preschool Female Healthcare Disparities / economics, statistics & numerical data* Humans Infant Infant, Newborn Male Medically Uninsured / statistics & numerical data Patient-Centered Care / economics, standards* Quality of Health Care Social Class United States |
| Grant Support | |
ID/Acronym/Agency:
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R40MC07844//PHS HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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