title: Racial health disparities among special health care needs children with mental disorders: do medical homes cater to their needs?
abstract: BACKGROUND
  A health care reform has been taking place to provide cost-effective and coordinated care. One method of achieving these goals is a patient-centered medical home (PCMH) model, which is associated with provision of quality care among children belonging to racial/ethnic minorities. Despite the potential of the PCMH for children of minority backgrounds, little is known about the extent to which minorities with mental disorders have the PCMH.
  
  
  OBJECTIVE
  The study examined racial/ethnic disparities among children with mental disorders in accessing care from the PCMH.
  
  
  METHODS
  The 2009-2010 National Survey of Children with Special Health Care Needs (CSHCN) was used for this analysis. Multivariate logistic regressions were applied to capture the racial/ethnic disparities and to analyze a composite outcome of the PCMH.
  
  
  RESULTS
  An estimated population size of 4 677 904 CSHCN with mental disorders was included. Among them, 59.94% of children reported to have received medical homes. Compared with white children, the odds of receiving any medical home services decreased among Hispanic children (odds ratio [OR] = 0.69; P < .05) and black children (OR = 0.70; P < .05). The likelihood of having a medical home was lower for Hispanic children than white children, when they had attention deficit hyperactivity disorder (ADHD; OR = 0.57; P < .05) and development delay (OR = 0.73; P < .05). Compared with white children with ADHD or depression having a medical home, the odds of black children with ADHD (OR = 0.63; P < .05) and depression (OR = 0.68; P < .05) having a medical home were lower.
  
  
  CONCLUSIONS
  There were significant racial/ethnic disparities among CSHCN with mental disorders, indicating several sizeable effects of each of the 5 components on Hispanic, black, and other children compared with white children. These differences could be a potential to improve racial/ethnic disparities.
authors: The University of Texas, Austin, TX, USA.
authors: Chanhyun
authors: C
authors: Park
authors: The University of Michigan, Ann Arbor, MI, USA.
authors: Xi
authors: X
authors: Tan
authors: The University of Michigan, Ann Arbor, MI, USA.
authors: Isha B
authors: IB
authors: Patel
authors: Penn State College of Medicine, Hershey, PA, USA.
authors: Amanda
authors: A
authors: Reiff
authors: The University of Michigan, Ann Arbor, MI, USA.
authors: Rajesh
authors: R
authors: Balkrishnan
authors: Samford University, Birmingham, AL, USA jchang1@samford.edu.
authors: Jongwha
authors: J
authors: Chang
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000458:organization & administration / Q000592:standards; D003156:Community Mental Health Services / Q000458:organization & administration / Q000592:standards; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D018802:Patient-Centered Care / Q000458:organization & administration / Q000592:standards*; D014481:United States
keywords: access to care; children; health outcomes; patient-centeredness; program evaluation