142nd APHA Annual Meeting and Exposition

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307841
Disparities in Quality of Healthcare and Community-based Services for Children with Developmental Disabilities

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 8:42 AM - 8:57 AM

Nancy Cheak-Zamora, PhD , Health Sciences, University of Missouri- Columbia, Columbia, MO
Audio (mp3) recording Recorded Presentation (mp4)
The Maternal Child Health Bureau identified six indicators essential in achieving coordinated, family-centered, community-based care for children with special healthcare needs (CSHCN).  Current studies examine only one indicator and focus on individual conditions limiting understanding of overall quality of care.

Using data from the 2009-10 National Survey of CSHCN (n=34,393), we examined indicators by child’s specific condition(s) including: physical (PC), mental (MC), developmental (DC), physical and mental (PMC), physical and developmental (PDC), mental and developmental (MDC) and physical, mental and developmental (PMDC).  Indicators include: partnering in decision making, adequate insurance, and access to medical home, early/continuous screening, community services and healthcare transition (HCT). Bivariate and multivariate analyses determined the association between groups and indicators. 

The majority of the sample had a PC (48%), MC (17%), or PMC (21%) with the remaining 15% split between DC, PDC, MDC, and PMDC.  CSHCN received medical home and HCT services least often.  Children with DC, alone or with another condition, were significantly less likely to receive each indicator (p<.0001) even after controlling for demographic and family-related characteristics.  Compared to children with PC, those with: PMDC had the lowest odds of having a medical home (61% decreased odds(DO)), adequate insurance (34% DO) and community services (67% DO);  MDC had the lowest odds of partnering in decision making (51% DO); DC had the lowest odds of receiving HCT (66% DO; p<.0001).

Children with DC receive quality healthcare and community-based services half as often as other CSHCN.  This disparity must be addressed by researchers, providers and policymakers.

Learning Areas:

Basic medical science applied in public health
Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public

Learning Objectives:
Discuss Maternal and Child Health Bureau’s designated quality of care indicators and the prevalence of receipt for CSHCN. Compare differences in receipt of quality of care indicators among children with various health conditions. Assess what variables predict receipt of each quality indicator.

Keyword(s): Children With Special Needs, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was principal investigator of this project and have utilized data from the National Survey of Children with Special Health Care Needs for several previous publications. Quality and Access to Care for children with special needs is one of my areas of expertise.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4053.0: Children with Special Health Care Needs: Treatment Models and Service Systems