title: Association of medical home care and disparities in emergency care utilization among children with special health care needs.
abstract: 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.
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. raphael@bcm.edu
authors.forename: Jean L
authors.initials: JL
authors.lastname: Raphael
authors.forename: Yiqun
authors.initials: Y
authors.lastname: Zhang
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.forename: Carl D
authors.initials: CD
authors.lastname: Tapia
authors.forename: Angelo P
authors.initials: AP
authors.lastname: Giardino
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data; D002675:Child, Preschool; D002908:Chronic Disease; D016001:Confidence Intervals; D003695:Delivery of Health Care; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D016017:Odds Ratio; D011320:Primary Health Care / Q000706:statistics & numerical data*; D014481:United States; D044465:White People / Q000706:statistics & numerical data