Background: In 1992, the American Academy of Pediatrics (AAP) developed the medical home as a model for uninterrupted and sustainable care to support optimal health outcomes. The AAP highlighted four critical principles for pediatric medical homes: (1) patient and family-centered partnership; (2) community-based system; (3) provision of high-quality uninterrupted care as the child transitions to adulthood; and (4) appropriate financing to sustain the medical home. Unfortunately, efforts to establish medical homes for all children have faced limited success. Objectives: This study aimed to explore state-level disparities in medical home prevalence for racial minority children. Methods: A secondary analysis of the 2016-2017 National Survey of Children’s Health (NSCH) was performed. The NSCH is a nationally representative parent-proxy survey of children in the United States. Child race/ethnicity was classified as “white, non-Hispanic” (W-NH), “black and/or Hispanic” (B/H), or “other” based on response to the prompt: “What is this child’s race/ethnicity?” Analysis compared W-NH and B/H children (n=62448). In the NSCH, medical home is a composite variable and refers to children who met all 5 of the following criteria: (1) a personal doctor or nurse; (2) a usual source for sick care; (3) family-centered care; (4) no problems getting needed referrals; and (5) effective care coordination when needed. State-specific disparities in medical home prevalence between W-NH and B/H children were analyzed with logistic regressions. Additionally, state-level weighted estimates for medical home prevalence were calculated for W-NH children and B/H children. All P values were 2-sided, with values less than 0.05 considered statistically significant. All calculations and analyses accounted for the complex survey design and were conducted using the statistical software R, version 3.5.2 (R Foundation). Results: In 42 of the 50 states examined, B/H children were found to have a significantly lower medical home prevalence (see Table). No significant association was identified between race and medical home status in the other 8 states. B/H children in Hawaii had the most positive risk difference (0.7%) and B/H children in West Virginia had the most negative risk difference (-28.0%) for medical home status when compared against their W-NH counterparts. In almost every state, B/H children had a lower prevalence for medical home status (Figure 1A), ranging from 25.2% (Nevada) to 52.5% (Maryland), with a national prevalence of 37.9%. For W-NH children, medical home prevalence ranged from 45.3% (Nevada) to 65.9% (Massachusetts), with a national average of 57.1% (Figure 1B). Conclusion: This study highlights racial disparities in health care quality across geographic boundaries. Further studies need to investigate these disparities, and public health initiatives should be pursued to aim to minimize the impact of these disparities.

Figure 1

Racial Disparities in Medical Home Status Prevalence in Children in the US (2016-2017 NSCH, n=62408*)

*62,448 subjects identified as white, black, or Hispanic, of which 40 were missing medical home data.

Figure 1

Racial Disparities in Medical Home Status Prevalence in Children in the US (2016-2017 NSCH, n=62408*)

*62,448 subjects identified as white, black, or Hispanic, of which 40 were missing medical home data.

Close modal