title: Disparities in unmet need for care coordination: the national survey of children's health.
abstract: OBJECTIVE
  To determine (1) the proportion of parents who report a need for and receipt of effective care coordination for their child, (2) whether unmet care coordination needs differ by children with special health care needs (CSHCN) status and sociodemographic characteristics, and (3) whether having a personal provider or family-centered care mitigates disparities.
  
  
  METHODS
  This study was a cross-sectional analysis of the 2007 National Survey for Children's Health, a nationally representative survey of 91 642 parents. Outcome measures were parent report of need for and lack of effective care coordination. We also examined the effect of parent report of having a personal provider and family-centered care. We conducted weighted bivariate and multivariate analyses.
  
  
  RESULTS
  Forty-one percent of parents reported that their child needed care coordination. Among those who needed care coordination, 31% did not receive effective coordination. CSHCN (41%) were more likely than children without special health care needs (26%; P < .001) to have unmet care coordination needs. Latino (40%) and black (37%) children were more likely to have unmet needs than white (27%; P < .001) children. These patterns remained in multivariate analysis. Having a personal provider decreased the odds of having unmet need for care coordination but did not attenuate disparities. Receiving family-centered care mitigated disparities associated with race/ethnicity but not with health status or health insurance.
  
  
  CONCLUSIONS
  A considerable proportion of parents reported their child needed more care coordination than they received. This was especially true for parents of CSHCN and parents of black and Latino children. Interventions that enhance family-centered care might particularly contribute to reducing racial/ethnic disparities.
authors: MPhil, MSc, Division of General Pediatrics, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA. sara.toomey@childrens.harvard.edu
authors: Sara L
authors: SL
authors: Toomey
authors: Alyna T
authors: AT
authors: Chien
authors: Marc N
authors: MN
authors: Elliott
authors: Jessica
authors: J
authors: Ratner
authors: Mark A
authors: MA
authors: Schuster
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology* / Q000208:ethnology; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006306:Health Surveys / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D033183:Interdisciplinary Communication; D008297:Male; D058996:Quality Improvement / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States; D035862:Vulnerable Populations / Q000208:ethnology / Q000706:statistics & numerical data*