Factors associated with parent report of access to care and the quality of care received by children 4-17 years of age- How do they differ in Georgia?

Background: We examined the factors associated with health care access and quality, top priorities in Georgia identified through the Title V Needs Assessment. Methods: Data from the 2007 National Survey of Children's Health were merged with the 2008 Area Resource File, and restricted to Georgia children ages 4-17 years (N=1,397). Study outcomes were access to care (timely utilization of preventive medical care in the previous 12 months - yes/no) and quality of care (whether care was compassionate, culturally-effective, and family-centered - higher/moderate/lower). The Andersen's model guided independent variable selection. Analysis included binary and multinomial logit models. Results: In our study population, 80.8% reported having access to care. The quality of care distribution was: higher (39.4%), moderate (30.6%), lower (30.0%). Compared to children who were never/intermittently insured in the previous 12 months, children with full/adequate (adjusted odds ratio [aOR]= 4.23 95%CI 2.49-7.17) and full/inadequate insurance (aOR 2.06 95%CI 1.03-4.12) were more likely to have access. Other factors positively associated with access were younger age (4-9 years) and being black, non-Hispanic. Children with strong social support had higher odds of perceiving the care received as higher (aOR 5.28 95%CI 2.86-9.74) or moderate (aOR 2.02 95%CI 1.05-3.88) quality versus lower quality when compared to those with weak support. Those with moderate support also fared better. Having special health care needs was also positively associated with quality; non-white race/ethnicity and income were negatively associated with quality. Conclusions: Assuring continuous, adequate insurance and stronger neighborhood support may positively impact health care access and quality respectively.