Racial and Ethnic Disparities in the Medical Home for Children Born Premature in the National Survey of Children's Health.

Brandon M Smith, Palak P Patel, Sara B Johnson, Christina Bethell
Author Information
  1. Brandon M Smith: Department of Pediatrics, Johns Hopkins University School of Medicine (BM Smith), Baltimore, Md. Electronic address: brandon.smith@jhmi.edu.
  2. Palak P Patel: Johns Hopkins University School of Medicine (PP Patel), Baltimore, Md. Electronic address: ppatel96@jhmi.edu.
  3. Sara B Johnson: Department of Pediatrics, Johns Hopkins University School of Medicine; Departments of Population, Family, and Reproductive Health and Mental Health, Johns Hopkins University Bloomberg School of Public Health (SB Johnson), Baltimore, Md. Electronic address: sjohnson@jhu.edu.
  4. Christina Bethell: Department of Pediatrics, Johns Hopkins University School of Medicine; Department of Population, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health (C Bethell), Baltimore, Md. Electronic address: cbethell@jhu.edu.

Abstract

OBJECTIVE: Children born premature are more likely to be from minoritized racial and ethnic groups and face chronic health and developmental problems. The medical home aims to comprehensively address health and social needs of all families. This study evaluates racial and ethnic disparities in the prevalence of a medical home among children born premature compared to children born full-term.
METHODS: A 2017-18 National Survey of Children's Health data set was used to calculate the medical home performance measure and subcomponents for children aged 0 to 17 born premature (n = 5633) or full-term (n = 45,819). Chi square and logistic regression assessed magnitude and significance of variations by race and ethnicity and prematurity status.
RESULTS: Prematurity prevalence differed by race and ethnicity (12.0% non-Hispanic Black [NHB], 12.8% Hispanic, 11.1% Multiracial/Other, 11.0% non-Hispanic White [NHW]). Minoritized children born premature had lower adjusted odds of receiving care in a medical home compared to NHW peers (eg, NHB adjusted odds ratio [aOR] 0.54 [95% confidence interval {CI}: 0.38-0.76] and Hispanic aOR 0.56 [95% CI: 0.40-0.79]). Differences were greater in magnitude among children born premature compared to full-term peers (eg, NHB premature aOR 0.54 [95% CI: 0.38-0.76] vs NHB full-term aOR 0.67 [95% CI: 0.58-0.78]), with similar results for "personal doctor/nurse" and "usual sick care."
CONCLUSIONS: Racial and ethnic disparities exist in the medical home among children born premature, some more pronounced than full-term peers. To deliver equitable care for all children, efforts are needed to expand access to and improve the medical home, including reliable routine and sick care and stronger family-provider relationships.

Keywords

MeSH Term

Child
Humans
Child Health
Ethnicity
Healthcare Disparities
Hispanic or Latino
Patient-Centered Care
Racial Groups
United States
White
Black or African American
Infant, Newborn
Infant
Child, Preschool
Adolescent
Health Status Disparities

Word Cloud

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