Disparities in the National Prevalence of a Quality Medical Home for Children With Asthma

ObjectiveThe aim of this study was to examine sociodemographic disparities in having a quality medical home among a nationally representative sample of children with asthma.MethodsThe study examined data from the 2003 National Survey of Children's Health to identify 8360 children aged 2–17 years with asthma. Risk factors including nonwhite race/ethnicity, income <200% of the federal poverty level (FPL), uninsured, parent education less than high school, and non-English language, were examined individually and as a profile of risk in relation to a quality medical home. Fourteen questions were used to measure 5 medical home features: access, continuity, comprehensiveness, family-centered care, and coordination. A poorer quality medical home was defined as ≤66 on a 100-point scale—corresponding to the feature being present less than “usually”—for each feature and for an overall score.ResultsBefore and after adjustment for demographics and asthma difficulties, most risks except less than high school parent education were related to a poorer quality medical home. Uninsured children had the highest odds of a poorer quality medical home overall (adjusted odds ratio [OR] 5.19, 95% confidence interval [CI] 3.52–7.65) and across most features, except for coordination. Children experiencing 3+ risks had 8.56 times the odds of a poorer quality medical home overall (95% CI 4.95–14.78) versus zero risks.ConclusionsThis study demonstrates large national disparities in a quality medical home for children with asthma. That disparities were most prevalent for the uninsured (insurance being a modifiable risk factor) suggests increasing coverage is essential to assuring that children obtain a quality medical home.