Asthma care quality for children with minority-serving providers.
OBJECTIVE
To compare asthma care quality for children with and without minority-serving providers.


METHODS
Cross-sectional telephone survey of parents, linked with a mailed survey of their children's providers.


METHODS
A Medicaid-predominant health plan and multispecialty provider group in Massachusetts.


METHODS
A total of 563 children with persistent asthma, identified by claims and encounter data. Main Exposure Whether the child's provider was minority serving (>25% of patients black or Latino). Outcomes Parent report of whether the child had (1) ever received inhaled steroids, (2) received influenza vaccination during the past season, and (3) received an asthma action plan in the past year.


RESULTS
In unadjusted analyses, Latino children and those with minority-serving providers were more likely to have never received inhaled steroids. In adjusted models, the odds of never receiving inhaled steroids were not statistically significantly different for children with minority-serving providers (odds ratio [OR], 1.29; 95% confidence interval [CI], 0.63-2.64), or for Latino vs white children (OR, 1.76; 95% CI, 0.74-4.18); odds were increased for children receiving care in community health centers (OR, 4.88; 95% CI, 1.70-14.02) or hospital clinics (OR, 4.53; 95% CI, 1.09-18.92) vs multispecialty practices. Such differences were not seen for influenza vaccinations or action plans.


CONCLUSIONS
Children with persistent asthma are less likely to receive inhaled steroids if they receive care in community health centers or hospital clinics. Practice setting mediated initially observed disparities in inhaled steroid use by Latino children and those with minority-serving providers. No differences by race/ethnicity or minority-serving provider were observed for influenza vaccinations or asthma action plans.
Galbraith
Alison A
AA
Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care and Harvard Medical School, 133 Brookline Ave, 6th Floor, Boston, MA 02215, USA. alison_galbraith@harvardpilgrim.org
Smith
Lauren A
LA
Bokhour
Barbara
B
Miroshnik
Irina L
IL
Sawicki
Gregory S
GS
Glauber
James H
JH
Hohman
Katherine H
KH
Gay
Charlene
C
Lieu
Tracy A
TA
D001741:Black or African American / Q000706:statistics & numerical data*; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003151:Community Health Centers / Q000592:standards; D003430:Cross-Sectional Studies; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008404:Massachusetts; D010044:Outpatient Clinics, Hospital / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D011787:Quality of Health Care