Racial and ethnic disparities in the quality of primary care for children

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Original Research

Racial and ethnic disparities in the quality of primary care for children

J Fam Pract. 2002 June;51(6):1-1

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References

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Address reprint requests to Gregory D. Stevens, PhD, MHS, Department of Health Policy and Management, Johns Hopkins University School of Hygiene and Public Health, 624 N. Broadway, Rm. 661, Baltimore, MD 21205. E-mail: gstevens@jhsph.edu.

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Third, because of the moderate response rate, the respondents in this study may not be fully representative of the population under study. Although respondents were demographically similar to nonrespondents, participants may have been more likely than nonrespondents to have children in poorer health status or have more negative experiences with the health care system. Although this does not threaten the internal validity of this study (because response rates did not differ substantially across racial groups), such bias could lead to lower overall estimates of primary care quality regardless of racial group.

Fourth, studies that rely on patient reporting to compare quality of care across racial groups often may capture racial and ethnic group variations in perceptions of care or different standards for assessing care. In this study, we used an instrument for assessing quality of care that relies heavily on factual reporting (eg, waiting times and receipt of particular services) rather than on satisfaction or performance ratings, so our study was less subject to these biases.

In conclusion, this study demonstrated significant differences in the quality of primary care for children across racial and ethnic groups. These findings in part suggest that ensuring adequate health insurance coverage may not be sufficient to reduce racial and ethnic disparities in quality of care. Although the cause or mechanism of these disparities in quality is not entirely established, the findings encourage careful additional monitoring of the delivery of primary care, in particular to minority children. At a minimum, health care providers and organizations should make primary care services more accessible to minority families, provide the services in a culturally and linguistically competent manner (to encourage the development of the physician-patient relationship), and communicate more effectively with families about the range of child health services offered.

*The Institute of Medicine defines primary care as “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.”⁵ The practice of primary care is best characterized as a set of attributes or functions that, only when performed together, constitute the delivery of primary care. Empirical studies have further delineated and operationalized 4 core attributes of primary care: first-contact care with a designated primary care physician; longitudinality, or ongoing care, with a physician or place of care; comprehensiveness of services; and coordination or integration of those services⁶Table 1.

Acknowledgments

The authors thank Barbara Starfield, MD, Lisa Cooper, MD, and Maria Trent, MD, for their thoughtful review of this manuscript. They also thank Jane Lyon for her generous support of and help in coordinating the study in the school district.