• Jean L Raphael, B Ashleigh Guadagnolo, Anne C Beal, and Angelo P Giardino.
• Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. Raphael@bcm.edu
• Acad Pediatr. 2009 Jul 1; 9 (4): 221-7.

ObjectiveRacial/ethnic disparities in access to care across a broad range of health services have been well established. In adults, having a medical home has been shown to reduce disparities. The objective of this study was to assess the extent to which children of different race/ethnicities receive primary care consistent with a medical home.MethodsWe conducted a secondary analysis of 84 101 children, ages 0-17, from the 2003-2004 National Survey of Children's Health, a nationwide household survey. The primary independent variable was race/ethnicity of the child. The main dependent variable was a medical home as defined by the American Academy of Pediatrics. Multiple logistic regression was conducted to investigate associations between race/ethnicity and having a medical home.ResultsThe odds of having a medical home were lower for non-Hispanic black (odds ratio [OR] 0.76, 95% confidence interval [95% CI] 0.69-0.83), Hispanic (OR 0.80, 95% CI 0.72-0.89), and other (OR 0.77, 95% CI 0.69-0.87) children compared with non-Hispanic white children after adjusting for sociodemographic variables. Specific components of a medical home for which minority children had a lower odds (P < .01) of having compared with white children included having a personal provider, a provider who always/usually spent enough time with them, and a provider who always/usually communicated well.ConclusionsMinority children experienced multiple disparities compared with white children in having a medical home. Study of individual medical home components has the potential to identify specific areas to improve disparities.

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