Youth Access to Medical Homes and Medical Home Components by Race and Ethnicity.

ABSTRACT

OBJECTIVES: Medical homes are an effective model of primary care. Historically, however, racial and ethnic minorities have not had equal access to medical homes. The present study estimated the national prevalence of youth's access to a medical home and its components by race and ethnicity. METHODS: We conducted secondary data analysis using the 2016-2017 National Survey of Children's Health, a nationally representative, cross-sectional survey of U.S. youth age 0-17 years (N = 62,308). We obtained weighted and unweighted descriptive statistics and conducted multivariate logit regression models. RESULTS: Although 49% of the total sample had access to a medical home, 57.1% of white youth had access compared to 37% of Hispanic youth and 39.7% of black youth. Among youth without a medical home, black youth had less access than white youth to a usual place for care (64.7% vs. 55.3%, adjusted odds ratio [aOR] = 0.82, 95% confidence interval [CI] 0.69-0.97) and family-centered care (78.1% vs. 66.7%, aOR = 0.64, 95% CI 0.52-0.79). Hispanic youth (68.2%) also had less access to family-centered care than white youth (aOR = 0.73, 95% CI 0.60-0.89). White youth were less likely to have access to effective care coordination, when needed, than Hispanic youth (46.2% vs. 53.5%, aOR = 1.35, 95% CI 1.09-1.66). CONCLUSIONS FOR PRACTICE Our findings suggest racial/ethnic disparities exist in youth's access to a medical home and its components. We posit the need for continued efforts to enhance access to medical homes for all youth. Future studies need to examine systemic barriers to youth's access to medical homes.