title: Disparities in Patient- and Family-Centered Care During US Children's Health Care Encounters: A Closer Examination.
abstract: Patient- and family-centered care (PFCC), which recognizes the family as an integral partner in high-quality clinical decision-making, is important to improving children's health care. Studies examining PFCC disparities in the general US pediatric population, however, are sparse, and use methodology that might mislead readers to overestimate effect sizes because of the high prevalence of high-quality PFCC. We address these issues using improved statistical modeling of conceptually-grounded disparity domains on more recent data.
  
  
  
  This study examined 22,942 children in the 2011 to 2013 Medical Expenditure Panel Surveys (pooled cross-section) with at least 1 health care visit in the previous year (eligible for PFCC questions). We used robust-adjusted multivariable Poisson regression to estimate prevalence rate ratios-closer estimates of true risk ratios of highly prevalent outcomes-of 4 measures of high-quality PFCC and a composite measure.
  
  
  
  Overall, PFCC quality prevalences were high, ranging from 95% to 97% across the 4 PFCC measures with 92% of parents reporting the composite measure. In multivariable analyses, lower prevalence of high-quality PFCC was consistently observed among publicly insured children (relative to the privately insured, prevalence rate ratios ranging from 0.978 to 0.984 across the PFCC measures; 0.962 in the composite) and children living in families below the poverty line (children at ≥400% of the poverty line had 1.018-1.045 times the prevalence of high-quality PFCC across the PFCC measures; 1.056 in the composite).
  
  
  
  Although prevalence rate ratio methodology revealed smaller and perhaps clinically insignificant disparities in US children's PFCC quality than previously portrayed, nonetheless, several statistically significant disparities remain. The most consistent disparities identify those most vulnerable to PFCC quality: publicly insured and impoverished children.
authors.affiliation: Department of Health Policy and Administration, Pennsylvania State University, The Pennsylvania State University, University Park.
authors.forename: William K
authors.initials: WK
authors.lastname: Bleser
authors.affiliation: Department of Health Policy and Administration, Pennsylvania State University, The Pennsylvania State University, University Park.
authors.forename: Sara I
authors.initials: SI
authors.lastname: Young
authors.affiliation: Department of Health Policy and Administration, Pennsylvania State University, The Pennsylvania State University, University Park. Electronic address: pym1@psu.edu.
authors.forename: Patricia Y
authors.initials: PY
authors.lastname: Miranda
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003142:Communication; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health; D008297:Male; D017057:Medically Uninsured; D015999:Multivariate Analysis; D010290:Parents; D018802:Patient-Centered Care / Q000592:standards*; D010817:Physician-Patient Relations; D016012:Poisson Distribution; D011203:Poverty; D011368:Professional-Family Relations; D011787:Quality of Health Care; D012044:Regression Analysis; D013997:Time Factors; D014481:United States
keywords: children; health care disparities; health care quality, access, and evaluation; patient-centered care; physician-patient relations