Socioeconomic and Racial Disparities in Parental Perception and Experience of Having a Medical Home, 2007 to 2011–2012

Diao, Kristen; Tripodis, Yorghos; Long, Webb E.; Garg, Arvin

doi:10.1016/j.acap.2016.07.006

Cited by 29 publications

(32 citation statements)

References 19 publications

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“…The impact of race/ethnicity was most pronounced during the first 5 years from diagnosis when cases who were Hispanic/other were found to be at an increased risk of respiratory ED visits. This is consistent with prior research indicating that children of low socioeconomic status and Hispanic/other children have restricted access to care and are less likely to have a normal source of care, potentially contributing to increased ED use to meet health care needs …”

Section: Discussionsupporting

confidence: 90%

“…This is consistent with prior research indicating that children of low socioeconomic status and Hispanic/other children have restricted access to care and are less likely to have a normal source of care, potentially contributing to increased ED use to meet health care needs. 25,26 In addition, earlier reports from our team have demonstrated that Hispanic children with cancer show an increased risk of infection-related death. 27 Respiratory infections could potentially be a significant contributor because we observed a >2-fold increase in the risk of ED visits for respiratory infections among cases who were Hispanic/other.…”

Section: Discussionmentioning

confidence: 97%

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Respiratory emergency department use from diagnosis through survivorship in children, adolescents, and young adults with cancer

Ramsay

Fluchel

et al. 2018

Cancer

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BACKGROUND Children and adolescents and young adults (AYAs) with cancer often experience severe respiratory morbidity and mortality from the therapies used to treat their cancers. Few studies have examined respiratory outcomes among this population using emergency department (ED) visits as an objective measure of respiratory health. METHODS ED visits for respiratory conditions were identified for children and AYAs diagnosed with cancer, 0‐25 years of age, from 1997 through 2012 (2535 cases) and compared with a birthdate‐matched and sex‐matched cohort without cancer drawn from the general population (7605 controls). Negative binomial regression with robust standard errors was used to estimate incidence rates, rate ratios (RRs), and 95% confidence intervals for primary respiratory ED visits, combined and by diagnosis (asthma, respiratory disease, and respiratory infection) from 1997 through 2015. Analyses were performed for new cases (0 to <5 years from diagnosis) and survivors (5‐18 years from diagnosis). RESULTS Subjects were followed for an average of 8 years (range, 0‐18 years). Relative to the comparison cohort, cancer cases had higher incidence rates for all types of respiratory ED visits over both follow‐up times. New cases had significantly higher RRs for any respiratory condition (RR, 4.14), respiratory disease (RR, 4.62), and respiratory infection (RR, 4.74). Among survivors, the RRs for any respiratory condition (RR, 2.00) and respiratory infection (RR, 2.10) were significantly elevated, although the magnitude tended to decline in survivorship. Demographic and clinical risk factors found to be associated with respiratory ED visits included Hispanic/other race/ethnicity, male sex, exposure to chemotherapy, diagnosis at a younger age, and a diagnosis of leukemia. CONCLUSIONS The results of the current study demonstrated that children and AYAs with cancer face an increased burden of respiratory complications compared with a comparison cohort without cancer from diagnosis through survivorship.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 97%

Respiratory emergency department use from diagnosis through survivorship in children, adolescents, and young adults with cancer

Ramsay

Fluchel

et al. 2018

Cancer

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“…There has been other literature to suggest that this comparison may affect how parents view their feelings of discharge readiness and capability to take care of a child with advanced medical needs. While not observed in this study, there may also be more pronounced feelings of mistrust and disparities in minority families accessing multidisciplinary services such as a medical home, [34,35] which may further encumber these families, and further investigation is needed. Special attention should be paid to these families to optimize communication with primary care providers and discharge readiness [2,36,37].…”

Section: Discussionmentioning

confidence: 69%

Viewpoints from families for improving transition from NICU-to-home for infants with medical complexity at a safety net hospital: a qualitative study

et al. 2019

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Background: We have limited information on families' experiences during transition and after discharge from the neonatal intensive care unit. Methods: Open-ended semi-structured interviews were conducted with English or Spanish-speaking families enrolled in Medicaid in an urban high-risk infant follow up clinic at a safety-net center, which serves preterm and high-risk term infants. We generated salient themes using inductive-deductive thematic analysis. Results: Twenty-one participants completed the study. The infant's median (IQR) birth weight was 1750 (1305, 2641) grams; 71% were Hispanic and 10% were Black non-Hispanic; 62% reported living in a neighborhood with 3-4th quartile economic hardship. All were classified as having chronic disease per the Pediatric Medical Complexity Algorithm and 67% had medical complexity. A conceptual model was constructed and the analysis revealed major themes describing families' challenges and ideas to support transition centered on the parent-child role and parent self-efficacy. The challenges were: (1) comparison to normal babies, (2) caregiver mental health, (3) need for information. Ideas to support transition included, (1) support systems, (2) interventions using mobile health technology (3) improved communication to the primary care provider and (4) information regarding financial assistance programs. Specific subthemes differed in frequency counts between infants with and without medical complexity. Conclusions: Families often compare their preterm or high-risk infant to their peers and mothers feel great anxiety and stress. However, families often found hope and resilience in peer support and cited that in addition to information needs, interventions using mobile health technology and transition and financial systems could better support families after discharge.

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“…The American Academy of Pediatrics encourages providers to use their roles in health care to identify child strengths and protective factors as well as risks, to understand families' cultural and personal beliefs and roles in decision making, and to connect families to resources (Hagan, Shaw, & Duncan, 2017). A current approach to improving primary care outcomes and improving parental perceptions of care was the Affordable Care Act's emphasis on the patient-centered medical home (PCMH) in 2010; however, as reported in this review, that attempt has not improved access to PCMHs for minority families or improved parent experiences of primary care (Diao, Tripodis, Long, & Garg, 2017).…”

mentioning

confidence: 89%

Pediatric Primary Care Relationships With African American Families: A Critical Review

Koschmann¹,

Hooke²

2019

Journal of Pediatric Health Care

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Introduction: High-quality primary care is critical to help African American families mitigate the effects of social determinants of health that negatively affect child health and well-being. At the core of primary care is a healthy relationship between the parent and provider. This critical review of the literature evaluates what is known about the parent−provider relationship for African Americans. Methods: We identified 277 studies in Ovid MEDLINE and screened them for inclusion. Data extraction and qualitative synthesis were used to describe what is known and identify themes. Results: Twelve cross-sectional analyses and one mixed cross-sectional and longitudinal design research studies were identified. Studies identified parent factors, provider factors, parent−provider interaction factors, and health care system factors that affected the parent−provider relationship. Discussion: The results identify best practices and future research directions for providers, which would improve pediatric primary care quality for African American children. J Pediatr Health Care.

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Socioeconomic and Racial Disparities in Parental Perception and Experience of Having a Medical Home, 2007 to 2011–2012

Cited by 29 publications

References 19 publications

Respiratory emergency department use from diagnosis through survivorship in children, adolescents, and young adults with cancer

Respiratory emergency department use from diagnosis through survivorship in children, adolescents, and young adults with cancer

Viewpoints from families for improving transition from NICU-to-home for infants with medical complexity at a safety net hospital: a qualitative study

Pediatric Primary Care Relationships With African American Families: A Critical Review

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