Disparities in the national prevalence of a quality medical home for children with asthma

Acad Pediatr. Jul-Aug 2009;9(4):234-41. doi: 10.1016/j.acap.2009.01.006. Epub 2009 Mar 28.


Objective: The aim of this study was to examine sociodemographic disparities in having a quality medical home among a nationally representative sample of children with asthma.

Methods: The study examined data from the 2003 National Survey of Children's Health to identify 8360 children aged 2-17 years with asthma. Risk factors including nonwhite race/ethnicity, income <200% of the federal poverty level (FPL), uninsured, parent education less than high school, and non-English language, were examined individually and as a profile of risk in relation to a quality medical home. Fourteen questions were used to measure 5 medical home features: access, continuity, comprehensiveness, family-centered care, and coordination. A poorer quality medical home was defined as < or =66 on a 100-point scale-corresponding to the feature being present less than "usually"-for each feature and for an overall score.

Results: Before and after adjustment for demographics and asthma difficulties, most risks except less than high school parent education were related to a poorer quality medical home. Uninsured children had the highest odds of a poorer quality medical home overall (adjusted odds ratio [OR] 5.19, 95% confidence interval [CI] 3.52-7.65) and across most features, except for coordination. Children experiencing 3+ risks had 8.56 times the odds of a poorer quality medical home overall (95% CI 4.95-14.78) versus zero risks.

Conclusions: This study demonstrates large national disparities in a quality medical home for children with asthma. That disparities were most prevalent for the uninsured (insurance being a modifiable risk factor) suggests increasing coverage is essential to assuring that children obtain a quality medical home.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Asthma / diagnosis
  • Asthma / epidemiology*
  • Asthma / therapy*
  • Child
  • Child Health Services / statistics & numerical data*
  • Child Welfare
  • Child, Preschool
  • Educational Status
  • Female
  • Health Care Surveys
  • Health Knowledge, Attitudes, Practice
  • Health Services Accessibility / statistics & numerical data
  • Health Status Disparities
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Insurance Coverage / statistics & numerical data
  • Male
  • Parent-Child Relations
  • Prevalence
  • Primary Health Care / organization & administration*
  • Quality of Health Care
  • Risk Factors
  • Severity of Illness Index
  • Socioeconomic Factors
  • Treatment Outcome
  • United States