title: Does receiving care in a medical home reduce racial/ethnic disparities in ED visits among children with asthma in the United States?
abstract: Evidence has shown the implementation of medical home model improves care quality and outcomes. However, it is not clear whether receiving care from a medical home has any impact on racial/ethnic disparities in emergency department (ED) use by children with asthma. This study using the US National Survey of Children with Special Health Care Needs, 2009-2010, estimated racial/ethnic disparities in ED use. Generalized liner models were used to examine factors associated with ED use. Racial/ethnic differences in ED use were attenuated after adjusting for socio-economic variables. Ratios of prevalence ratios were calculated to examine the effect modification of medical home on ED use associated with race/ethnicity. The adjusted prevalence ratio of ED use of the Black to non-Hispanic White was 1.51 (95% confidence interval (CI): 1.36-1.67) with medical home and 1.35 (95% CI: 1.24-1.47) without medical home. Among those with care from a medical home Latino children had higher ED use compared with White children. There is no evidence that the self-reported care from a medical home narrows the gaps in ED use between non-Hispanic White and Black or Latino children with asthma.
authors.affiliation: 1 Center for Family and Community Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Susan X
authors.initials: SX
authors.lastname: Lin
authors.affiliation: 1 Center for Family and Community Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Younge
authors.affiliation: 2 Departments of Pediatrics and Population Health Sciences and Policy , Icahn School of Medicine at Mount Sinai, New York, NY, USA.|3 Center for Child Health and Policy and Department of Pediatrics UH Rainbow Babies & Children's Hospital and Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: Kleinman
keywords: Access/availability; ED use; NS-CSHCN; United States; asthma; children; disparities; medical home; paediatric care; race/ethnicity