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Title of Journal: Matern Child Health J

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Abbravation: Maternal and Child Health Journal

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Springer US

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10.1002/cta.2197

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1573-6628

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Does a Medical Home Mediate Racial Disparities in

Authors: Amanda C Bennett Kristin M Rankin Deborah Rosenberg
Publish Date: 2012/09/14
Volume: 16, Issue: 2, Pages: 330-338
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Abstract

This study extends mediation analysis techniques to explore whether and to what extent differential access to a medical home explains the black/white disparity in unmet healthcare needs among children with special healthcare needs CSHCN Data were obtained from the 2007 National Survey of Children’s Health with analyses limited to nonHispanic white and black CSHCN n = 14677 The counterfactual approach to mediation analysis was used to estimate odds ratios for the natural direct and indirect effects of race on unmet healthcare needs Overall 430  of white CSHCN and 604  of black CSHCN did not have a medical home Additionally 88  of white CSHCN and 153  of black CSHCN had unmet healthcare needs The natural indirect effect indicates that the odds of unmet needs among black CSHCN are elevated by approximately 20  as a result of their current level of access to the medical home rather than access at a level equal to white CSHCN ORNIE = 12 95  CI = 11 13 The natural direct effect indicates that even if black CSHCN had the same level of access to a medical home as white CSHCN blacks would still have 60  higher odds of unmet healthcare needs than whites ORNDE = 16 95  CI = 11 24 The racial disparity in unmet healthcare needs among CSHCN is only partially explained by disparities in having a medical home Ensuring all CSHCN have equal access to a medical home may reduce the racial disparity in unmet needs but will not completely eliminate it

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