1. Disparities for Latino Children in the Receipt of Timely Medical Care David Brousseau MD, MS, Jennifer Yauck MS, Raymond Hoffmann PhD, Ann Nattinger MD, MPH, Glenn Flores MD

2. Background Latino children: population –Largest minority racial/ethnic group = 16% –California: largest racial/ethnic group Latino children: health –Sub-optimal health status –Fewer physician visits –Lack health insurance –Less likely to have primary care provider Effect on quality of care ?

3. Latino quality of care Adherence to accepted standards –Lower likelihood of vision screening –Decreased use of inhaled steroids Self/Parent reported quality of care –No studies specifically looking at children –No studies controlling for confounders

4. Objective To compare the parent-reported ability of children to get timely medical care among Latino, White and African-American children

5. Methods Population: –2000 Medical Expenditure Panel Survey (MEPS) –Children < 18 years of age with a usual source of care All analyses weighted to represent national averages

6. Methods Timely medical care –1) Timely routine care from a provider –2) Timely illness or injury care from an office, clinic or ED –3) Phone help from a provider –4) Brief wait time with an appointment Scoring –4 point Likert scale, except Brief wait time

7. Methods: Analysis Primary outcome measure: –Not receiving the highest quality primary care Always receiving timely medical care Shortest waits for Brief wait time Univariate analysis by race/ethnicity –Analyzed using Chi-square

8. Methods: Multiple regression Latinos as the referent group Adjusted for: –Age, sex, health status, special health care needs –Insurance type, highest education With and without language in model Odds ratios

9. Results 4,120 children –Weighted to represent 47 million children –Average age: 8 years –51% male

10. Results: Unweighted Race/ethnicity Insurance

11. Results: Univariate analysis LatinoWhiteAfrican- American Routine care *56%46% Illness/injury care39%34%36% Phone help *60%51%53% Brief wait time *64%45%56% * P < 0.005

12. Results: OR for Latinos compared to Whites Without language 95% CIWith language 95% CI Routine care 1.281.04-1.561.190.95-1.50 Illness care1.040.79-1.390.880.64-1.20 Phone help1.371.16-1.621.281.07-1.54 Brief wait time 1.961.66-2.321.651.38-1.99

13. Results: OR for Latinos compared to African-Americans Without language 95% CIWith language 95% CI Routine care 1.481.15-1.981.381.04-1.82 Illness care 1.090.75-1.610.900.60-1.36 Phone help 1.291.05-1.581.200.96-1.50 Brief wait time 1.431.16-1.761.190.95-1.49

14. Conclusion Latino children experience marked disparities in obtaining timely medical care The disparities are only partially explained by language differences Improvements are needed in the delivery and efficiency of medical care for Latino children