Association of Medical Home Care and Disparities in Emergency Care Utilization Among Children With Special Health Care Needs

被引:53
作者
Raphael, Jean L. [1 ]
Zhang, Yiqun [2 ]
Liu, Hao [2 ]
Tapia, Carl D. [1 ]
Giardino, Angelo P. [1 ]
机构
[1] Baylor Coll Med, Dept Pediat, Houston, TX 77030 USA
[2] Baylor Coll Med, Duncan Canc Ctr, Houston, TX 77030 USA
关键词
healthcare disparities; healthcare services utilization; medical home; ETHNIC DISPARITIES; UNITED-STATES; ACCESS; QUALITY; RACE/ETHNICITY; EXPENDITURES; DEFINITION; SERVICES; IMPACT; INCOME;
D O I
10.1016/j.acap.2009.05.002
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Objective.-The aim of this study was to determine whether having a medical home is associated with a reduction of racial/ethnic disparities in emergency care utilization by children with special health care needs (CSHCN). Methods.-We conducted a secondary analysis of 35 301 children, aged 0 to 17, from the 2005-2006 National Survey of Children with Special Health Care Needs. The primary dependent variable was emergency care utilization, defined as 1 or more emergency care encounters in the last 12 months. The primary independent variables were race/ethnicity and type of care (medical home, usual source of care, no medical home/no usual source of care). Multiple logistic regression was conducted to investigate associations between race/ethnicity, type of care, and emergency care utilization. Results.-Analysis of type of care and its interactions with race/ethnicity showed that non-Hispanic black children with a medical home had higher odds (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.03-1.54) of emergency care utilization compared with non-Hispanic white children with a medical home. The odds of having 1 or more emergency care visits were higher for non-Hispanic black children (OR 1.38, 95% CI 1.22-1.56) compared with non-Hispanic white children after controlling for sociodemographic variables. Having a medical home was associated with lower odds of emergency care utilization (OR 0.81, 95% CI 0.72-0.90) compared with having neither a medical home nor a usual source of care. Conclusions.-Emergency care utilization for CSHCN differed significantly according to race/ethnicity. Having a medical home may be associated with a reduction in disparities in this fragile population.
引用
收藏
页码:242 / 248
页数:7
相关论文
共 37 条
[1]  
[Anonymous], UN TREATM CONFR RAC
[2]  
Bartman BA, 1997, J HEALTH CARE POOR U, V8, P214
[3]  
BETHELL C, 2003, EVALUATION MED HOME
[4]  
Bethell CD, 2004, PEDIATRICS, V113, P1529
[5]  
Bethell CD, 2002, AMBUL PEDIATR, V2, P38, DOI 10.1367/1539-4409(2002)002<0038:ICWSHC>2.0.CO
[6]  
2
[7]  
Blumberg Stephen J, 2008, Vital Health Stat 1, P1
[8]   Quality of primary care and subsequent pediatric emergency department utilization [J].
Brousseau, David C. ;
Hoffmann, Raymond G. ;
Nattinger, Ann B. ;
Flores, Glenn ;
Zhang, Yinghua ;
Gorelick, Marc .
PEDIATRICS, 2007, 119 (06) :1131-1138
[9]   Primary Care Quality and Subsequent Emergency Department Utilization for Children in Wisconsin Medicaid [J].
Brousseau, David C. ;
Gorelick, Marc H. ;
Hoffmann, Raymond G. ;
Flores, Glenn ;
Nattinger, Ann B. .
ACADEMIC PEDIATRICS, 2009, 9 (01) :33-39
[10]  
*CHILD AD HLTH MEA, 2009, MEAS MED HOM RES MAN