title: Can the Medical Home eliminate racial and ethnic disparities for transition services among Youth with Special Health Care Needs?
abstract: The Medical Home (MH) is shown to improve health outcomes for Youth with Special Health Care Needs (YSHCN). Some MH services involve Transition from pediatric to adult providers to ensure YSHCN have continuous care. Studies indicate racial/ethnic disparities for Transition, whereas the MH is shown to reduce health disparities. This study aims to (1) Determine the Transition rate for YSHCN with a MH (MH Transition) nationally, and by race/ethnicity (2) Identify which characteristics are associated with MH Transition (3) Determine if racial/ethnic disparities exist after controlling for associated characteristics, and (4) Identify which characteristics are uniquely associated with each race/ethnic group. National survey data were used. YSCHN with a MH were grouped as receiving Transition or not. Characteristics included race, ethnicity (Non-Hispanic (NH), Hispanic), sex, health condition effect, five special health care need categories, education, poverty, adequate insurance, and urban/rural residence. Frequencies, chi-square, and logistic regression were used to calculate rates and define associations. Alpha was set to 0.05. About 57.0% of YSHCN received MH Transition. Rates by race/ethnicity were 59.0, 45.5, 60.2, 41.9, and 44.6% for NH-White, NH-Black, NH-Multiple race, NH-Other, and Hispanic YSHCN, respectively. Disparities remained between NH-White and NH-Black YSHCN. All characteristics except urban/rural status were associated. Adequate insurance was associated for all race/ethnic groups, except NH-Black YSHCN. Almost 57.0% of YSHCN received MH Transition. Disparities remained. Rates and associated characteristics differed by race/ethnic group. Culturally tailored interventions incorporating universal factors to improve MH Transition outcomes are warranted.
authors.affiliation: Louisiana State University Health Sciences Center School of Medicine, Department of Pediatrics, New Orleans, LA 70112, USA. Nicole.Richmond@la.gov
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Richmond
authors.forename: Tri
authors.initials: T
authors.lastname: Tran
authors.forename: Susan
authors.initials: S
authors.lastname: Berry
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002662:Child Health Services / Q000458:organization & administration; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000379:methods; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005191:Family Characteristics; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D020380:Needs Assessment; D018802:Patient-Centered Care; D012959:Socioeconomic Factors