Racial and ethnic disparities in indicators of a primary care medical home for children

Acad Pediatr. 2009 Jul-Aug;9(4):221-7. doi: 10.1016/j.acap.2009.01.011. Epub 2009 May 31.


Objective: Racial/ethnic disparities in access to care across a broad range of health services have been well established. In adults, having a medical home has been shown to reduce disparities. The objective of this study was to assess the extent to which children of different race/ethnicities receive primary care consistent with a medical home.

Methods: We conducted a secondary analysis of 84 101 children, ages 0-17, from the 2003-2004 National Survey of Children's Health, a nationwide household survey. The primary independent variable was race/ethnicity of the child. The main dependent variable was a medical home as defined by the American Academy of Pediatrics. Multiple logistic regression was conducted to investigate associations between race/ethnicity and having a medical home.

Results: The odds of having a medical home were lower for non-Hispanic black (odds ratio [OR] 0.76, 95% confidence interval [95% CI] 0.69-0.83), Hispanic (OR 0.80, 95% CI 0.72-0.89), and other (OR 0.77, 95% CI 0.69-0.87) children compared with non-Hispanic white children after adjusting for sociodemographic variables. Specific components of a medical home for which minority children had a lower odds (P < .01) of having compared with white children included having a personal provider, a provider who always/usually spent enough time with them, and a provider who always/usually communicated well.

Conclusions: Minority children experienced multiple disparities compared with white children in having a medical home. Study of individual medical home components has the potential to identify specific areas to improve disparities.

MeSH terms

  • Adolescent
  • Child
  • Child Health Services / organization & administration*
  • Child Welfare*
  • Child, Preschool
  • Confidence Intervals
  • Cross-Sectional Studies
  • Ethnicity
  • Female
  • Group Homes / organization & administration
  • Health Care Costs
  • Health Status Disparities
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Infant
  • Insurance Coverage / statistics & numerical data
  • Male
  • Needs Assessment
  • Primary Health Care / organization & administration*
  • Primary Health Care / standards*
  • Primary Health Care / trends
  • Probability
  • Quality of Health Care
  • Racial Groups
  • Risk Assessment
  • Socioeconomic Factors
  • United States