Disparities in Children's Health Care Quality: Selected Examples from the National Healthcare Quality and Disparities Reports, 2008

Disparities in Children's Health Care Quality
Selected Examples from the National Healthcare Quality and Disparities Reports, 2008
Fact Sheet
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Since 2003, the Agency for Healthcare Research and Quality has produced the National Healthcare Quality Report and the National Healthcare Disparities Report. Despite improvements, differences persist in health care quality among children in racial and ethnic minority groups. Children in low-income families and uninsured families also experience poorer quality care. This fact sheet discusses differences between groups in terms of relative rates, which is the ratio of the comparison group (e.g., Black) to a baseline group (e.g., White).

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Contents
Introduction
Disparities Among Racial and Ethnic Groups
Income and Insurance
Location
Quality and Disparities Reports Charts Related to Children and Adolescents
For More Information

Introduction
Since 2003, the Agency for Healthcare Research and Quality (AHRQ) has produced the National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR). Although improvements have been seen in health care quality and some disparities have been reduced or eliminated, differences persist in health care quality among children in racial and ethnic minority groups. Children in low-income families and uninsured families also experience poorer quality care. In some cases, location can make a difference in health care quality, as regional differences are seen in certain measures.

For many measures, children overall experience poor quality. For example, 60.6% of overweight children have never been told by a health care provider that they are overweight. Fifty-five percent of parents have never been advised that smoking in the house is harmful to their children. Almost 40% of children have never been screened for vision problems. Thirty-four percent of parents have never been advised about the need for car seats. Sixty-one percent of children ages 12-17 with a major depressive episode have not received treatment. A little more than 40% of children with special health care needs whose parents report a need for care coordination among different providers do not receive it.

This fact sheet discusses differences between groups in terms of relative rates, which is the ratio of the comparison group (e.g., Black) to a baseline group (e.g.,White). For example, a relative rate of 2.0 means that children in that group are twice as likely to receive poorer quality care. Relative rates equal to or greater than 1.5 are highlighted as areas for improvement.

The NHQR and NHDR lack some measures on important child health topics. In addition, limited data are available for some groups, especially for relatively small racial and ethnic populations of children (e.g., Asian and Pacific Islanders [API]). Still, the reports offer many measures that indicate ongoing disparities in key areas of health care.

Disparities Among Racial and Ethnic Groups
Among racial and ethnic groups, Whites had better or similar rates in almost every area (effectiveness, patient centeredness, timeliness, care coordination), except patient safety. Figures 1-3 show relative rates for lack of prenatal care, admissions for preventable conditions, and lack of family-centered care for children with special health care needs. Figures 2 and 3 also address income, which is discussed below.

Additional areas for improvement include:

Sometimes/never able to get appointment for routine care as soon as wanted: Black/White, 1.7; Hispanic/Non-Hispanic White, 1.9.
Emergency department visits of 6 hours or more in which patient was admitted to the hospital or transferred to another facility: Black/White, 1.5.
For some measures, some racial and ethnic minority groups had better rates than Whites:

Did not have height and weight measuredi: Black/White, 0.84.
Admissions for preventable conditionsii (APIs; go to Figure 2).
Dialysis patients not registered on transplant waiting list: API/White, 0.87.

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i Measuring height and weight is an important precursor to assessing children’s body mass index for overweight or obesity.
ii Higher rates of hospitalizations for conditions such as asthma and diabetes are an indicator of poor quality, because many hospitalizations can be prevented with high-quality accessible ambulatory care (e.g., by primary care providers and outpatient specialty care).

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Care for Hispanic children needs improvement in several areas. Hispanic children are twice as likely as White children to lack up-to-date immunizations and to experience poor provider-patient communication. They are 2.5 times as likely to lack height and weight measurements. However, in two areas related to prevention, Hispanic children had better rates than White children. The relative rate for overweight children not told they were overweight and for parents never given advice that smoking in the house is harmful was 0.9.


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Disparities in Children's Health Care Quality: Selected Examples from the National Healthcare Quality and Disparities Reports, 2008