title: The parent-provider relationship: does race/ethnicity concordance or discordance influence parent reports of the receipt of high quality basic pediatric preventive services?
abstract: Recent research among adults suggests that having a provider of the same race/ethnicity may enhance the quality of health care above and beyond just having any regular source of care. It is not known whether such relationships exist in pediatric care. The purpose of this study is to identify the distribution and methods by which families have a race/ethnicity concordant provider of well-child care and examine whether differences exist in the receipt of basic preventive services (BPS) and family-centered care (FCC) among those with concordant, discordant, and no regular providers. Analyses are stratified by geography to assess whether urban versus nonurban setting moderates these differences. This study uses publicly available data from the 2000 National Survey of Early Childhood Health (NSECH), a nationally representative, cross-sectional telephone survey of parents of children ages 4-35 months (n = 1,996). African Americans and Latinos were more likely than whites to lack a regular provider of well-child care (60.9% and 65.7% vs. 50.6%) and less likely to have a concordant provider (9.8% and 5.7% vs. 38.5%) (P < .001). African Americans with a regular provider were about three times more likely to establish a concordant relationship in urban versus nonurban settings (32.4% vs. 12.5%, P < .01). No statistically significant differences in BPS or FCC were found by concordance versus discordance for any group, a finding that held regardless of geographic setting. White children with no regular provider received better BPS than those with a discordant provider (e.g., excellent BPS of 37.2% vs. 27.1%, P < .05), but children with no regular provider were more likely than those with either concordant or discordant providers to have lower FCC in one (Latinos, whites) or three domains (African Americans). Despite racial/ethnic differences in the likelihood of having a concordant regular provider of well-child care, no disparities were found in BPS or FCC associated with discordance, even after stratification by urban/nonurban setting. Lacking a regular provider was associated with lower FCC versus having either a concordant or discordant provider, suggesting that efforts to improve these aspects of well-child care might focus less on linking children with a race/ethnicity concordant provider and more on social, cultural, and linguistic factors that impact having any regular provider.
authors.affiliation: Division of Community Health, University of Southern California, Keck School of Medicine, 1000 South Fremont Avenue, Building A7, Alhambra, CA 91803, USA. gstevens@usc.edu
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Stevens
authors.forename: Ritesh
authors.initials: R
authors.lastname: Mistry
authors.forename: Barry
authors.initials: B
authors.lastname: Zuckerman
authors.forename: Neal
authors.initials: N
authors.lastname: Halfon
mesh_terms: D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003625:Data Collection; D005006:Ethnicity; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010290:Parents / Q000523:psychology*; D010372:Pediatrics; D011315:Preventive Medicine; D011320:Primary Health Care; D011368:Professional-Family Relations; D011787:Quality of Health Care; D014481:United States