Racial and ethnic disparities in indicators of a primary care medical home for children.
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.
Raphael
Jean L
JL
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. Raphael@bcm.edu
Guadagnolo
B Ashleigh
BA
Beal
Anne C
AC
Giardino
Angelo P
AP
D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D002669:Child Welfare; D002675:Child, Preschool; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D016352:Group Homes / Q000458:organization & administration; D017048:Health Care Costs; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D020380:Needs Assessment; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards* / Q000639:trends; D011336:Probability; D011787:Quality of Health Care; D044469:Racial Groups; D018570:Risk Assessment; D012959:Socioeconomic Factors; D014481:United States