• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on Web of Science (3)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Medical Practice  • Medical Practice, Other  • Pediatrics  • Pediatrics, Other  • Public Health  • Immunization  • Pulmonary Diseases  • Asthma  • Quality of Care  • Quality of Care, Other  • Drug Therapy  • Drug Therapy, Other  • Emergency Medicine  • Immunology  • Allergy  • Alert me on articles by topic  Social Bookmarking   What's this?

Alison A. Galbraith, MD, MPH; Lauren A. Smith, MD, MPH; Barbara Bokhour, PhD; Irina L. Miroshnik, MS; Gregory S. Sawicki, MD, MPH; James H. Glauber, MD, MPH; Katherine H. Hohman, MPH; Charlene Gay, BA; Tracy A. Lieu, MD, MPH

Arch Pediatr Adolesc Med. 2010;164(1):38-45.

Objective  To compare asthma care quality for children with and without minority-serving providers.

Design  Cross-sectional telephone survey of parents, linked with a mailed survey of their children's providers.

Setting  A Medicaid-predominant health plan and multispecialty provider group in Massachusetts.

Participants  A total of 563 children with persistent asthma, identified by claims and encounter data.

Main Exposure  Whether the child's provider was minority serving (>25% of patients black or Latino).

Outcomes  Parent report of whether the child had (1) ever received inhaled steroids, (2) received influenza vaccination during the past season, and (3) received an asthma action plan in the past year.

Results  In unadjusted analyses, Latino children and those with minority-serving providers were more likely to have never received inhaled steroids. In adjusted models, the odds of never receiving inhaled steroids were not statistically significantly different for children with minority-serving providers (odds ratio [OR], 1.29; 95% confidence interval [CI], 0.63-2.64), or for Latino vs white children (OR, 1.76; 95% CI, 0.74-4.18); odds were increased for children receiving care in community health centers (OR, 4.88; 95% CI, 1.70-14.02) or hospital clinics (OR, 4.53; 95% CI, 1.09-18.92) vs multispecialty practices. Such differences were not seen for influenza vaccinations or action plans.

Conclusions  Children with persistent asthma are less likely to receive inhaled steroids if they receive care in community health centers or hospital clinics. Practice setting mediated initially observed disparities in inhaled steroid use by Latino children and those with minority-serving providers. No differences by race/ethnicity or minority-serving provider were observed for influenza vaccinations or asthma action plans.

Author Affiliations: Center for Child Health Care Studies, Department of Population Medicine (Drs Galbraith and Lieu, and Ms Gay), and Department of Population Medicine (Mss Miroshnik and Hohman), Harvard Medical School and Harvard Pilgrim Health Care, Boston; Massachusetts Department of Public Health, Boston (Dr Smith); Center for Health Quality, Outcomes and Economic Research, Boston University School of Public Health and Edith Nourse Rogers Memorial Veterans Hospital, Bedford (Dr Bokhour); the Pulmonary Division (Dr Sawicki), and Division of General Pediatrics, Children's Hospital Boston (Dr Lieu); and the Neighborhood Health Plan, Boston, Massachusetts (Dr Glauber).

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?