Department of Pediatrics, Mattel Children's Hospital, University of California, Los Angeles, CA, USA.
Pediatrics. 2010 Jun;125(6):1159-67. doi: 10.1542/peds.2009-1994. Epub 2010 May 3.
The goal was to examine racial/ethnic and language disparities in family-centered care (FCC) and in FCC components for children with special health care needs (CSHCN).
Bivariate and multivariate logistic regression analyses of data from the 2005-2006 National Survey of CSHCN were performed.
A total of 66% of CSHCN with a health visit in the past year received FCC. In adjusted analyses, we found lower odds of FCC for Latino (odds ratio: 0.53 [95% confidence interval: 0.45-0.63]), African-American (odds ratio: 0.60 [95% confidence interval: 0.52-0.69]), and other (odds ratio: 0.58 [95% confidence interval: 0.43-0.78]) children, compared with white children, and for children in households with a non-English primary language (odds ratio: 0.48 [95% confidence interval: 0.36-0.64]), compared with those in households with English as the primary language. These disparities persisted after adjustment for child health (condition severity and emotional, behavioral, and developmental needs), socioeconomic (poverty level, parental education, household composition, and residing in a metropolitan statistical area), and access (insurance type, usual source of care, and having a personal physician) factors. Of these factors, only condition severity was significantly associated with the racial/ethnic disparities; none was significantly associated with the language disparities. Disparities were found for Latino and African-American children and children in households with a non-English primary language for the FCC components of time spent with the provider and sensitivity to the family's values and customs.
Robust FCC racial/ethnic and language disparities exist for CSHCN; initial efforts to address these disparities should focus on increasing provider time and cultural sensitivity.
本研究旨在探讨有特殊健康需求儿童（CSHCN）的家庭为中心的护理（FCC）及其各组成部分中存在的种族/民族和语言差异。
采用 2005-2006 年全国 CSHCN 调查数据，进行了二元和多元逻辑回归分析。
在过去一年中接受过健康访视的 CSHCN 中，有 66%接受了 FCC。在调整分析中，我们发现与白人儿童相比，拉丁裔（比值比：0.53[95%置信区间：0.45-0.63]）、非裔美国人（比值比：0.60[95%置信区间：0.52-0.69]）和其他种族（比值比：0.58[95%置信区间：0.43-0.78]）儿童接受 FCC 的可能性较低，与家中使用非英语作为主要语言的儿童（比值比：0.48[95%置信区间：0.36-0.64]）相比，接受 FCC 的可能性较低。在调整了儿童健康状况（病情严重程度和情绪、行为和发育需求）、社会经济状况（贫困水平、父母教育程度、家庭构成和居住在都会统计区）和获得医疗服务的情况（保险类型、常规医疗服务来源和有私人医生）等因素后，这些差异仍然存在。在这些因素中，只有病情严重程度与种族/民族差异显著相关；没有一个与语言差异显著相关。在接受者交流时间和对家庭价值观和习俗的敏感性方面，拉丁裔和非裔美国儿童以及家中使用非英语作为主要语言的儿童在 FCC 组成部分中存在明显差异。
对于 CSHCN，FCC 存在明显的种族/民族和语言差异；解决这些差异的初步努力应侧重于增加提供者的时间和文化敏感性。
