1. The Primary Care Experience of Hispanic Children: Current Disparities and Trends in Access to and Quality of Care William Freeman, MPH Health Scientist Administrator NHQR/DR Production Team

2. Presenter Disclosures: No Relationships to Disclose - No personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months

3. Data Sources Principal Data Source: Principal Data Source: AHRQ’s Medical Expenditure Panel Survey (MEPS); data years 2003-2007 Secondary Sources: Secondary Sources: NCHS’s National Health Interview Survey (NHIS) and National Immunization Survey (NIS)

4. Methodology: Quality Measures Included in Analysis Access to the healthcare system (3) Access to the healthcare system (3) (i.e. reported insurance status) Usual source of primary care (3) Usual source of primary care (3) Utilization of preventive & common services (5) Utilization of preventive & common services (5) Receipt of patient-centered (4-measure composite) (1) Receipt of patient-centered (4-measure composite) (1) Receipt of timely of routine care (2) Receipt of timely of routine care (2)

5. Methodology Notes Comparison between Hispanic children (all races) and non-Hispanic White children (following NHQR/DR methods). Comparison between Hispanic children (all races) and non-Hispanic White children (following NHQR/DR methods). 2-part disparities test: test of significance and 10% difference. 2-part disparities test: test of significance and 10% difference. Trending utilized gap analysis and change over time. Trending utilized gap analysis and change over time. Multi-stratified analyses, where possible. Multi-stratified analyses, where possible.

6. Results Summary Access: Hispanic children – 13.2% uninsured; non-Hisp. White – 7%. Gap remained the same from 2002-2007. Access: Hispanic children – 13.2% uninsured; non-Hisp. White – 7%. Gap remained the same from 2002-2007. Usual Primary Care Provider: Gap closed. Hispanic Children – improved 1% per year, but remained the same for non-Hispanic White. Usual Primary Care Provider: Gap closed. Hispanic Children – improved 1% per year, but remained the same for non-Hispanic White. Office Visits within the Past Year: Rates did not change significantly for either group, gap remained 10-12% over period. Office Visits within the Past Year: Rates did not change significantly for either group, gap remained 10-12% over period.

7. Access to the HC System Uninsured All Year Uninsured All Year Cost Burden* (>10%) Cost Burden* (>10%) Source: MEPS

8. Usual Sources of Care Usual Primary Usual Primary Care Provider Care Provider Usual Source of Usual Source of Care for Those Care for Those in Poor Health in Poor Health Source: MEPS Source: NCHS, National Health Interview Survey

9. Preventive Services Dental Visit within Past Year: In 2007, Hispanic children only 37.1% compared to 52.8% for non-Hispanic Whites Dental Visit within Past Year: In 2007, Hispanic children only 37.1% compared to 52.8% for non-Hispanic Whites Source: MEPS

10. Preventive Services Receipt of All Recommended Vaccinations*: Receipt of All Recommended Vaccinations*: Source: NCHS, National Immunization Survey a Percent of children, ages 19 to 35 months, receiving at least 4 doses of diphtheria-tetanus-acellular pertussis (DTaP), at least 3 doses of polio, at least 1 dose of measles-mumps-rubella (MMR), at least 3 doses of Haemophilus influenzae B (Hib), and at least 3 doses of hepatitis B antigens. The vaccines included in this measure are based on the corresponding Healthy People 2010 objective which does not include varicella vaccine or vaccines added to the recommended schedule after 1998 for children up to 35 months of age. More information can be found in the Measure Specifications Appendix.

11. Patient-Centered Care Composite: 1. sometimes or never listening carefully Composite: 1. sometimes or never listening carefully 2. explaining things clearly 2. explaining things clearly 3. respecting what they had to say 3. respecting what they had to say 4. spending enough time with them 4. spending enough time with them Gap decreased such that with the most recent year there was no statistically significant difference. Gap decreased such that with the most recent year there was no statistically significant difference. Source: MEPS

12. Timeliness Children who had an appointment for routine health care in the last 12 months who got appointments for routine care as soon as wanted Children who had an appointment for routine health care in the last 12 months who got appointments for routine care as soon as wanted Gap decreased ~ 40%, but when match insurance status gap decreased ~ 60% Gap decreased ~ 40%, but when match insurance status gap decreased ~ 60% PUBLIC INSURANCE ONLY Source: MEPS

13. Recommendations to Advance Hispanic Children’s Health Increase focus of available resources on access to the system (attainment of insurance), and receiving primary care preventive services, where gaps are stagnant when compared to non- Hispanic Whites Increase focus of available resources on access to the system (attainment of insurance), and receiving primary care preventive services, where gaps are stagnant when compared to non- Hispanic Whites Once insured, most Hispanic children were able to attain a usual source of care, and receive care that was patient-centered comparable to non- Hispanic Whites Once insured, most Hispanic children were able to attain a usual source of care, and receive care that was patient-centered comparable to non- Hispanic Whites