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The Primary Care Experience of Hispanic Children: Current Disparities and Trends in Access to and Quality of Care. William Freeman, MPH Health Scientist Administrator NHQR/DR Production Team. Presenter Disclosures: No Relationships to Disclose - No personal financial relationships - PowerPoint PPT Presentation
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The Primary Care Experience of Hispanic Children:
Current Disparities and Trends in Access to and Quality of Care
William Freeman, MPHHealth Scientist Administrator
NHQR/DR Production Team
Presenter Disclosures:
No Relationships to Disclose - No personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months
Data Sources
Principal Data Source:AHRQ’s Medical Expenditure Panel Survey (MEPS); data years 2003-2007
Secondary Sources: NCHS’s National Health Interview Survey (NHIS) and National Immunization Survey (NIS)
Methodology: Quality Measures Included in Analysis
Access to the healthcare system (3)(i.e. reported insurance status)
Usual source of primary care (3) Utilization of preventive & common
services (5) Receipt of patient-centered (4-measure
composite) (1) Receipt of timely of routine care (2)
Methodology Notes
Comparison between Hispanic children (all races) and non-Hispanic White children (following NHQR/DR methods).
2-part disparities test: test of significance and 10% difference.
Trending utilized gap analysis and change over time.
Multi-stratified analyses, where possible.
Results Summary
Access: Hispanic children – 13.2% uninsured; non-Hisp. White – 7%. Gap remained the same from 2002-2007.
Usual Primary Care Provider: Gap closed. Hispanic Children – improved 1% per year, but remained the same for non-Hispanic White.
Office Visits within the Past Year: Rates did not change significantly for either group, gap remained 10-12% over period.
Access to the HC System
Uninsured All Year
2003 2004 2005 2006 20070
2
4
6
8
10
12
14
16
Hispanic
Non-His-panic, White
Cost Burden* (>10%)
2006 20070
5
10
15
20
25
Hispanic, All RacesNon-Hispanic, White
Source: MEPSSource: MEPS
Usual Sources of Care
Usual Primary Care Provider
Usual Source of Care for Those in Poor Health
2003 2004 2005 2006 20070
2
4
6
8
10
12
14
16
Hispanic
Non-His-panic, White
2004 2005 2006 2007 2008
93.9
95.5
89.390.4
87.9
97.2
94.593.1
96
Hispanic, All Races Non-Hispanic, White
Source: MEPS Source: NCHS, National Health Interview Survey
Preventive Services
Dental Visit within Past Year: In 2007, Hispanic children only 37.1% compared to 52.8% for non-Hispanic Whites
Source: MEPS
2003 2004 2005 2006 20070
10
20
30
40
50
60
Hispanic - All RacesNon-Hispanic White
Preventive Services
Receipt of All Recommended Vaccinations*:
Poor Near Poor Middle High0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
NHWHispanic
2003 2004 2005 2006 2007 200872
74
76
78
80
82
84
His-panic, All RacesNon-His-panic, White
Source: NCHS, National Immunization Survey
a Percent of children, ages 19 to 35 months, receiving at least 4 doses of diphtheria-tetanus-acellular pertussis (DTaP), at least 3 doses of polio, at least 1 dose of measles-mumps-rubella (MMR), at least 3 doses of Haemophilus influenzae B (Hib), and at least 3 doses of hepatitis B antigens. The vaccines included in this measure are based on the corresponding Healthy People 2010 objective which does not include varicella vaccine or vaccines added to the recommended schedule after 1998 for children up to 35 months of age. More information can be found in the Measure Specifications Appendix.
Patient-Centered Care
Composite: 1. sometimes or never listening carefully 2. explaining things clearly 3. respecting what they had to say 4. spending enough time with them Gap decreased such that with the most recent year there was no
statistically significant difference.
2003 2004 2005 2006 20070
1
2
3
4
5
6
7
8
9
10
Hispanic - All RacesNon-Hispanic White
Source: MEPS
Timeliness Children who had an appointment for routine health care in
the last 12 months who got appointments for routine care as soon as wanted
Gap decreased ~ 40%, but when match insurance status gap decreased ~ 60%
2003 2004 2005 2006 20070
2
4
6
8
10
12
14
Hispanic - All Races
Non-hispanic White
2003 2004 2005 2006 20070
2
4
6
8
10
12
14
16
Hispanic - All RacesNon-hispanic White
PUBLIC INSURANCE ONLY
Source: MEPS
Recommendations to Advance Hispanic Children’s Health
Increase focus of available resources on access to the system (attainment of insurance), and receiving primary care preventive services, where gaps are stagnant when compared to non-Hispanic Whites
Once insured, most Hispanic children were able to attain a usual source of care, and receive care that was patient-centered comparable to non-Hispanic Whites
