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Maternal and Child Health Journal

, Volume 16, Supplement 1, pp 6–13 | Cite as

Medical Home Access Among American Indian and Alaska Native Children in 7 States: National Survey of Children’s Health

  • Danielle T. Barradas
  • Charlan D. Kroelinger
  • Michael D. Kogan
Article

Abstract

To describe the prevalence of medical home among American Indian and Alaska Native children (AIAN) compared to non-Hispanic white (NHW) children and identify areas for improvement in the provision of care within a medical home. Prevalence of medical home, defined as family-centered, comprehensive, coordinated, compassionate, culturally effective care, including a personal doctor or nurse and usual care location, was estimated using 2007 National Survey of Children’s Health data. Analyses included 1–17 year-olds in states reporting AIAN race as a distinct category (Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma, and South Dakota, n = 9,764). Associations between medical home and demographic (child’s age, household education and income, and state) and health-related [child’s insurance status, special health care need status, and past year Indian Health Service (IHS) utilization] characteristics were assessed among AIAN children. Overall, the prevalence of medical home was 27 % lower among AIAN children (42.6, 95 % CI = 34.4–50.8) than NHW children (58.3, 95 % CI = 56.2–60.4). Child’s age (adjusted OR [aOR] = 2.7, 95 % CI = 1.3–5.6) was significantly associated with medical home. IHS utilization was associated with medical home among AIAN children with private insurance (aOR = 0.2, 95 % CI = 0.1–0.4), but not among uninsured or publicly insured children. Care coordination and family-centered care were noted areas for improvement among AIAN children. Less than half of AIAN children had a medical home. Future studies should further examine the intersection between insurance and IHS to determine if enhanced coordination is needed for this population, which is often served by multiple federally-funded health-related programs.

Keywords

Medical home Disparities American Indians National Survey of Children’s Health 

Notes

Acknowledgments

Many thanks to Drs. Deborah Rosenberg, Ph.D., and Kristin Rankin, Ph.D., for their statistical expertise and support, and to Jennifer Irving, M.P.H, for her thoughtful review of this manuscript. The findings and conclusions found in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Supplementary material

10995_2012_990_MOESM1_ESM.doc (42 kb)
Supplementary material 1 (DOC 42 kb)

References

  1. 1.
    American Academy of Pediatrics, Medical Home Initiatives for Children with Special Health Care Needs Project Advisory Committee of the. (2002). Policy statement: The medical home. Pediatrics, 110, 184–186.Google Scholar
  2. 2.
    Romaire, M. A., & Bell, J. F. (2010). The medical home, preventive care screenings, and counseling for children: Evidence from the medical expenditure panel survey. Academic Pediatric, 10, 338–345.CrossRefGoogle Scholar
  3. 3.
    Strickland, B. B., Jones, J. R., Ghandour, R. M., et al. (2011). The medical home: Health care access and impact for children and youth in the United States. Pediatrics, 127, 604–611.PubMedCrossRefGoogle Scholar
  4. 4.
    Raphael, J. L., Guadagnolo, A., Beal, A. C., et al. (2009). Racial and ethnic disparities in indicators of a primary care medical home for children. Academic Pediatric, 9, 221–227.CrossRefGoogle Scholar
  5. 5.
    Zephier, E., Himes, J. H., Story, M., et al. (2006). Increasing prevalences of overweight and obesity in Northern Plains American Indian children. Archives of Pediatrics and Adolescent Medicine, 160, 34–39.PubMedCrossRefGoogle Scholar
  6. 6.
    SEARCH for Diabetes in Youth Study Group. (2006). The burden of diabetes mellitus among US youth: Prevalence estimates form the SEARCH for diabetes in youth study. Pediatrics, 118(4), 1510–1518.Google Scholar
  7. 7.
    Brim, S. N., Rudd, R. A., Funk, R. H., et al. (2008). Asthma prevalence among US children in underrepresented minority populations: American Indian/Alaska Native, Chinese, Filipino, and Asian Indian. Pediatrics, 122, 217–222.CrossRefGoogle Scholar
  8. 8.
    Shaughnessy, L., Doshi, S. R., & Jones, S. E. (2004). Attempted suicide and associated health risk behaviors among Native American high school students. Journal of School Health, 74, 177–182.PubMedCrossRefGoogle Scholar
  9. 9.
    Centers for Disease Control and Prevention. (2009). Deaths related to 2009 pandemic influenza A (H1N1) among American Indian/Alaska Natives—12 states, 2009. MMWR. Morbidity and Mortality Weekly Report, 58, 1341–1344.Google Scholar
  10. 10.
    Hoilette, L. K., Clark, S. J., Gebremariam, A., et al. (2009). Usual source of care and unmet need among vulnerable children: 1998–2006. Pediatrics, 123, e214–e219.PubMedCrossRefGoogle Scholar
  11. 11.
    Lee, K., Palacio, C., Alexandraki, I., et al. (2011). Increasing access to health care providers through medical home model may abolish racial disparity in diabetes care: Evidence from a cross-sectional study. Journal of the National Medical Association, 103, 250–256.PubMedGoogle Scholar
  12. 12.
    Beal, A., Hernandez, S., & Doty, M. (2009). Latino access to the patient-centered medical home. Journal of General Internal Medicine, 24(Suppl 3), 514–520.PubMedCrossRefGoogle Scholar
  13. 13.
    Blumberg, S. J., Foster, E. B., Frasier, A. M., et al. (2011). Design and operation of the national survey of children’s health, 2007. National Center for Health Statistics. http://ftp.cdc.gov/pub/Health_Statistics/NCHS/slaits/nsch07/2_Methodology_Report/NSCH_Design_and_Operations_052109.pdf. Accessed March 15, 2011.
  14. 14.
    Adams, P. F., Martinez, M. E., & Vickerie, J. L. (2010). Summary health statistics for the U.S. population: National health interview survey, 2009. National Center for Health Statistics. Vital Health Statistics, 10(248).Google Scholar
  15. 15.
    Kogan, M. D., Newacheck, P. W., Blumberg, S., et al. (2010). Underinsurance among children in the United States. New England Journal of Medicine, 363, 841–851.PubMedCrossRefGoogle Scholar
  16. 16.
    O’Malley, A. S., Grossman, J. M., Cohen, G. R., et al. (2010). Are electronic medical records helpful for care coordination? Experiences of physician practices. Journal of General Internal Medicine, 25, 177–185.PubMedCrossRefGoogle Scholar
  17. 17.
    Graetz, I., Reed, M., Rundall, T., et al. (2009). Care coordination and electronic health records: Connecting clinicians. AMIA Annu Symp Proc, 2009, 208–212.PubMedGoogle Scholar
  18. 18.
    IHS Fact Sheets—IHS Year 2011 Profile. Available at: http://www.ihs.gov/PublicAffairs/IHSBrochure/Profile2011.asp. Accessed April 17, 2011.
  19. 19.
    IHS Fact Sheets—Indian Health Service FY 2010 Budget. Available at: http://www.ihs.gov/PublicAffairs/IHSBrochure/Budget10.asp. Accessed April 17, 2011.
  20. 20.
    IHS Fact Sheets—Partnership with the Centers for Medicare and Medicaid Services. Available at: http://www.ihs.gov/PublicAffairs/IHSBrochure/PartnerMed.asp. Accessed April 17, 2011.
  21. 21.
    Bernard, S. J., Paulozzi, L. J., Wallace, D. L., et al. (2007). Fatal injuries among children by race and ethnicity—United States, 1999–2002. MMWR Surveill Summ, 56, 1–16.PubMedGoogle Scholar
  22. 22.
    Roesler, J., Petcoff, M., Azam, A., et al. (2009). Nonfatal suicide attempts and other self-inflicted harm. Beltrami County youths, 2002–2006. Minnesota Medicine, 92, 53–55.PubMedGoogle Scholar
  23. 23.
    Mitchell, D. A., & Lassiter, S. L. (2006). Addressing health care disparities and increasing workforce diversity: The next step for the dental, medical, and public health professions. American Journal of Public Health, 96, 2093–2097.PubMedCrossRefGoogle Scholar
  24. 24.
    Betancourt, J. R., Green, A. R., Carrillo, J. E., & Park, E. R. (2005). Cultural competence and health care disparities: Key perspectives and trends. Health Affairs, 24, 499–505.PubMedCrossRefGoogle Scholar
  25. 25.
    Staiger, D. O., Auerbach, D. I., & Buerhaus, P. I. (2009). Comparison of physician workforce estimates and supply projections. JAMA, 302, 1674–1680.PubMedCrossRefGoogle Scholar
  26. 26.
    Buerhaus, P. I., Auerbach, D. I., & Staiger, D. O. (2009). The recent surge in nurse employment: Causes and implications. Health Affairs, 12, w657–w668.CrossRefGoogle Scholar
  27. 27.
    MacDowell, M., Glasser, M., & Fitts, M. et al. (2010). A national view of rural health workforce issues in the USA. Rural Remote Health, 10, 1531. Epub July 26, 2010.Google Scholar

Copyright information

© Springer Science+Business Media, LLC (outside the USA)  2012

Authors and Affiliations

  • Danielle T. Barradas
    • 1
  • Charlan D. Kroelinger
    • 1
  • Michael D. Kogan
    • 2
  1. 1.Division of Reproductive Health, National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaUSA
  2. 2.Maternal and Child Health BureauHealth Resources and Services AdministrationRockvilleUSA

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