Receipt of Transition Services Within a Medical Home: Do Racial and Geographic Disparities Exist?

Louisiana State University Health Sciences Center, School of Medicine, Department of Pediatrics/Louisiana Office of Public Health, Children's Special Health Services Program, 1010 Common Street Suite 610, New Orleans, LA 70112, USA.
Maternal and Child Health Journal (Impact Factor: 2.24). 08/2011; 15(6):742-52. DOI: 10.1007/s10995-010-0635-2
Source: PubMed


(1) Rank states and southern region by racial disparity between black and white Youth with Special Health Care Needs (YSHCN) for Healthcare Transition receipt; (2) Determine if a racial and geographic disparity exists after control of characteristics.
The 05/06 National Survey of Children with Special Health Care Needs data were used. A composite of Medical Home and Transition Outcome Measures captured Healthcare Transition. If both were met, Healthcare Transition was received; otherwise, if neither were met, it was not received. Race was grouped as Non-Hispanic black or white. Census Bureau regions defined geography. South was categorized as Deep South or remaining southern states. Characteristics included sex, age, health condition effect, education, poverty, adequate insurance, and metropolitan status. Observations were limited to YSHCN. Chi-square and logistic regression were conducted. Alpha was set to .05.
A national 42% healthcare transition rate, and 25% racial gap was calculated (higher rate among white YSHCN). White YSHCN had more than twice, and Midwestern had 44% higher Healthcare Transition odds in regression analysis; sex, health condition effect, insurance, and education remained significant. For the Southern region, the Healthcare Transition rate was 38% with a 26% racial gap. White YSHCN had about 2.6 higher odds, and southern geography was not associated in regression analysis. Education, poverty, adequate insurance, and health condition effect remained significant.
A low Healthcare Transition rate was found, and disparities are poignant. Culturally salient intervention programs to address racial and geographic disparities are needed for Healthcare Transition eligible YSHCN.

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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.
    No preview · Article · Apr 2011 · Maternal and Child Health Journal
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    ABSTRACT: The aims of the study were to test the hypotheses that youth with special health care needs (YSHCN) with a medical care transition plan are more likely to use dental care during the transition from adolescence to young adulthood and that different factors are associated with dental utilization for YSHCN with and YSHCN without functional limitations. National Survey of CSHCN (2001) and Survey of Adult Transition and Health (2007) data were analyzed (N = 1,746). The main predictor variable was having a medical care transition plan, defined as having discussed with a doctor how health care needs might change with age and having developed a transition plan. The outcome variable was dental care use in 2001 (adolescence) and 2007 (young adulthood). Multiple variable Poisson regression models with robust standard errors were used to estimate covariate-adjusted relative risks (RR). About 63 % of YSHCN had a medical care transition plan and 73.5 % utilized dental care. YSHCN with a medical care transition plan had a 9 % greater RR of utilizing dental care than YSHCN without a medical care transition plan (RR 1.09; 95 % CI 1.03-1.16). In the models stratified by functional limitation status, having a medical care transition plan was significantly associated with dental care use, but only for YSHCN without functional limitations (RR 1.11; 95 % CI 1.04-1.18). Having a medical care transition plan is significantly associated with dental care use, but only for YSHCN with no functional limitation. Dental care should be an integral part of the comprehensive health care transition planning process for all YSHCN.
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    ABSTRACT: Objective To review and exemplify the complexities and challenges in healthcare transition from the pediatric medical home to the adult medical home for patients with Type 1 and Type 2 diabetes mellitus, and to highlight the importance of this topic to adult clinical endocrinologists.Methods We performed a literature search using PubMed and multiple key words. To set the scene for discussions, we also reviewed landmark publications in the general healthcare transition literature over the last several decades: we have provided a brief historical perspective at the start of our discussions.Results Given the critical importance of successful healthcare transition, there is little empirical evidence on key aspects of these transitions. The vast majority of the literature focuses on Type 1 diabetes since, historically, this form has been the province of pediatric patients. However, the increasing incidence and prevalence of pediatric patients with Type 2 diabetes makes investigations vital for this patient population too. The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study has proved informative in this regard.Conclusion Crossing the chasm between pediatric and adult healthcare remains a remarkably flawed transition process. Healthcare transition should be a planned process of discussing and preparing pediatric patients for the transition and then ensuring continued care as an adult: the greater the collaboration of pediatric and adult endocrinologists in this process, the greater the chance of a successful transition.
    Full-text · Article · Jan 2014 · Endocrine Practice
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