Tri Tran

Receipt of Transition Services Within a Medical Home: Do Racial and Geographic Disparities Exist?

Objectives 1. Rank states and southern region by racial disparity between black and white Youth with Special Health Care Needs (YSHCN) for Healthcare Transition receipt; 2. Determine if a racial and geographic disparity exists after control of characteristics. Methods The 05/06 National Survey of Children with Special Health Care Needs data were used. A composite of Medical Home and Transition Outcome Measures captured Healthcare Transition. If both were met, Healthcare Transition was received; otherwise, if neither were met, it was not received. Race was grouped as Non-Hispanic black or white. Census Bureau regions defined geography. South was categorized as Deep South or remaining southern states. Characteristics included sex, age, health condition effect, education, poverty, adequate insurance, and metropolitan status. Observations were limited to YSHCN. Chi-square and logistic regression were conducted. Alpha was set to .05. Results A national 42% Healthcare Transition rate, and 25% racial gap was calculated (higher rate among white YSHCN). White YSHCN had more than twice, and Midwestern had 44% higher Healthcare Transition odds in regression analysis; sex, health condition effect, insurance, and education remained significant. For the Southern region, the Healthcare Transition rate was 38% with a 26% racial gap. White YSHCN had about 2.6 higher odds, and southern geography was not associated in regression analysis. Education, poverty, adequate insurance, and health condition effect remained significant. Conclusions A low Healthcare Transition rate was found, and disparities are poignant. Culturally salient intervention programs to address racial and geographic disparities are needed for Healthcare Transition eligible YSHCN.

Can the Medical Home Eliminate Racial and Ethnic Disparities for Transition Services Among Youth with Special Health Care Needs

The Medical Home (MH) is shown to improve health outcomes for Youth with Special Health Care Needs (YSHCN). Some MH services involve Transition from pediatric to adult providers to ensure YSHCN have continuous care. Studies indicate racial/ethnic disparities for Transition, whereas the MH is shown to reduce health disparities. This study aims to (1) Determine the Transition rate for YSHCN with a MH (MH Transition) nationally, and by race/ethnicity (2) Identify which characteristics are associated with MH Transition (3) Determine if racial/ethnic disparities exist after controlling for associated characteristics, and (4) Identify which characteristics are uniquely associated with each race/ethnic group. National survey data were used. YSCHN with a MH were grouped as receiving Transition or not. Characteristics included race, ethnicity (Non-Hispanic (NH), Hispanic), sex, health condition effect, five special health care need categories, education, poverty, adequate insurance, and urban/rural residence. Frequencies, chi-square, and logistic regression were used to calculate rates and define associations. Alpha was set to 0.05. About 57.0% of YSHCN received MH Transition. Rates by race/ethnicity were 59.0, 45.5, 60.2, 41.9, and 44.6% for NH-White, NH-Black, NH-Multiple race, NH-Other, and Hispanic YSHCN, respectively. Disparities remained between NH-White and NH-Black YSHCN. All characteristics except urban/rural status were associated. Adequate insurance was associated for all race/ethnic groups, except NH-Black YSHCN. Almost 57.0% of YSHCN received MH Transition. Disparities remained. Rates and associated characteristics differed by race/ethnic group. Culturally tailored interventions incorporating universal factors to improve MH Transition outcomes are warranted.

Late Newborn Hearing Screening, Late Follow-up, and Multiple Follow-Ups Increase the Risk of Incomplete Audiologic Diagnosis Evaluation

Abstract This study aimed to determine whether the following factors were associated with an incomplete audiologic diagnosis evaluation (IAD): age at newborn screening, length of time between newborn hearing screening (NHS) and first follow-up, and total number of follow-ups. 2011-2013 linked Louisiana Early Hearing Detection and Intervention data and birth records were analyzed. Logistic regression models were used to evaluate different effects of the predictors on IAD among birth weight groups. In very low birth weight newborns, there were no statistical associations of IAD with age at NHS or length of time between NHS and first follow-up, but there was with the number of follow-up appointments. Among low birth weight or normal weight newborns, risk of IAD was significantly increased in babies with NHS > 30 days of age; length of time between NHS and first follow-up > 30 days; and having more than one follow-up. In order to reduce the number of infants who fail to complete the audiologic diagnosis evaluation, it is necessary to conduct NHS early, expedite follow-up, and decrease the number of follow-ups.

Enhancing State Medical Home Capacity through a Care Coordination Technical Assistance Model

Introduction A practice-based care coordination (CC) model was developed by Louisiana’s Title V Children’s Special Health Services (CSHS) program to meet the overwhelming needs of the New Orleans post-Katrina population. The pilot clinic demonstrated an improvement in medical home (MH) capacity over the course of 3 months. The purpose of the current study is to evaluate the replicability of the model and sustainability of MH improvement over at least 2 years, while identifying factors that may modify the effect of the intervention. Methods The CSHS CC model utilizing a practice based care coordinator was implemented in 15 academic primary care pediatric clinics. Increase in MH capacity was determined using the MH Index-Short Version (MHI-SV) tool. Results The analysis of the MHI-SV scores for the ten clinics with >2 years of data demonstrated a significant improvement with each of the ten MHI-SV indicators. The mean clinic MHI-SV score improved from 19.70 to 34.15 on a scale of 10–50. Characteristics associated with the greatest MHI score improvement were rural geographic location, having an electronic health record, and using social workers or nurses as care coordinators. Characteristics associated with lower MHI scores were physician or care coordinator turnover and using stand-alone databases rather than tracking CC activities within the central patient record. Conclusion This study provides a flexible framework for implementing CC services in pediatric, family medicine, and medicine-pediatric practices, and demonstrates the value of CC as a driver for improvement in medical home capacity.

Time Trend and Factors Associated with Late Enrollment in Early Intervention among Children with Permanent Hearing Loss in Louisiana 2008-2013

This study aimed to identify the time trend of and factors associated with late enrollment in early intervention (EI) services among children with permanent hearing loss (HL) born between 2008 and 2013 in Louisiana. 2008-2013 linked Louisiana Early Hearing Detection and Intervention, birth records, EarlySteps (IDEA, Part C), Parent-Pupil Education Program, and Medicaid data were analyzed. Logistic regression models were used to evaluate the trend and associations of mother and child’s demographic and hearing loss characteristics with late EI enrollment. Results of data analyses did not show any trend of late enrollment in EI services from 2008 to 2013. Delayed diagnosis and mild or unilateral HL were strongly associated with late enrollment. Appropriate strategies to resolve problems relating to missed diagnosis during newborn hearing screening and to convince parents of children with HL to enroll soon after diagnosis of HL will contribute to success of early EI enrolment in the state.

Erratum to: Receipt of Transition Services Within a Medical Home: Do Racial and Geographic Disparities Exist?

Table 7 has been revised to correct the placement error for the household Federal Poverty Level (FPL) variable reference. In the corrected table, the reference household income level is equal to or below 200% FPL. The odds ratios published in the original article are correct, and thus remain the same in the amended table. The edit made in this table does not change either the results or the discussion sections.