Disparities in the national prevalence of a quality medical home for children with asthma.
OBJECTIVE
The aim of this study was to examine sociodemographic disparities in having a quality medical home among a nationally representative sample of children with asthma.


METHODS
The study examined data from the 2003 National Survey of Children's Health to identify 8360 children aged 2-17 years with asthma. Risk factors including nonwhite race/ethnicity, income <200% of the federal poverty level (FPL), uninsured, parent education less than high school, and non-English language, were examined individually and as a profile of risk in relation to a quality medical home. Fourteen questions were used to measure 5 medical home features: access, continuity, comprehensiveness, family-centered care, and coordination. A poorer quality medical home was defined as < or =66 on a 100-point scale-corresponding to the feature being present less than "usually"-for each feature and for an overall score.


RESULTS
Before and after adjustment for demographics and asthma difficulties, most risks except less than high school parent education were related to a poorer quality medical home. Uninsured children had the highest odds of a poorer quality medical home overall (adjusted odds ratio [OR] 5.19, 95% confidence interval [CI] 3.52-7.65) and across most features, except for coordination. Children experiencing 3+ risks had 8.56 times the odds of a poorer quality medical home overall (95% CI 4.95-14.78) versus zero risks.


CONCLUSIONS
This study demonstrates large national disparities in a quality medical home for children with asthma. That disparities were most prevalent for the uninsured (insurance being a modifiable risk factor) suggests increasing coverage is essential to assuring that children obtain a quality medical home.
Stevens
Gregory D
GD
Center for Community Health Studies, Department of Family Medicine, University of Southern California Keck School of Medicine, 1000 South Fremont Ave, Unit #80, Alhambra, California 91803, USA. gstevens@usc.edu
Pickering
Trevor A
TA
Seid
Michael
M
Tsai
Kai Ya
KY
D000293:Adolescent; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002669:Child Welfare; D002675:Child, Preschool; D004522:Educational Status; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D010287:Parent-Child Relations; D015995:Prevalence; D011320:Primary Health Care / Q000458:organization & administration*; D011787:Quality of Health Care; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States