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Can the Medical Home Eliminate Racial and Ethnic Disparities for Transition Services Among Youth with Special Health Care Needs?

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Abstract

The Medical Home (MH) is shown to improve health outcomes for Youth with Special Health Care Needs (YSHCN). Some MH services involve Transition from pediatric to adult providers to ensure YSHCN have continuous care. Studies indicate racial/ethnic disparities for Transition, whereas the MH is shown to reduce health disparities. This study aims to (1) Determine the Transition rate for YSHCN with a MH (MH Transition) nationally, and by race/ethnicity (2) Identify which characteristics are associated with MH Transition (3) Determine if racial/ethnic disparities exist after controlling for associated characteristics, and (4) Identify which characteristics are uniquely associated with each race/ethnic group. National survey data were used. YSCHN with a MH were grouped as receiving Transition or not. Characteristics included race, ethnicity (Non-Hispanic (NH), Hispanic), sex, health condition effect, five special health care need categories, education, poverty, adequate insurance, and urban/rural residence. Frequencies, chi-square, and logistic regression were used to calculate rates and define associations. Alpha was set to 0.05. About 57.0% of YSHCN received MH Transition. Rates by race/ethnicity were 59.0, 45.5, 60.2, 41.9, and 44.6% for NH-White, NH-Black, NH-Multiple race, NH-Other, and Hispanic YSHCN, respectively. Disparities remained between NH-White and NH-Black YSHCN. All characteristics except urban/rural status were associated. Adequate insurance was associated for all race/ethnic groups, except NH-Black YSHCN. Almost 57.0% of YSHCN received MH Transition. Disparities remained. Rates and associated characteristics differed by race/ethnic group. Culturally tailored interventions incorporating universal factors to improve MH Transition outcomes are warranted.

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Acknowledgments

The authors would like to acknowledge Dionka R. Pierce for her assistance with discussion and interpretation of study results.

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Authors and Affiliations

  1. Louisiana Office of Public Health, Children’s Special Health Services Program/Louisiana State University Health Sciences Center School of Medicine, Department of Pediatrics, 1450 Poydras Street, New Orleans, LA, 70112, USA

    Nicole E. Richmond & Susan Berry

  2. Louisiana Office of Public Health, Maternal and Child Health Program/Louisiana State University Health Sciences Center School of Medicine, Department of Pediatrics, 1450 Poydras Street, New Orleans, LA, 70112, USA

    Tri Tran

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  1. Nicole E. Richmond
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Correspondence to Nicole E. Richmond.

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Table 6 Transition national performance measure questions
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Richmond, N.E., Tran, T. & Berry, S. Can the Medical Home Eliminate Racial and Ethnic Disparities for Transition Services Among Youth with Special Health Care Needs?. Matern Child Health J 16, 824–833 (2012). https://doi.org/10.1007/s10995-011-0785-x

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