Association of Maternal-Clinician Ethnic Concordance With Latinx Youth Receipt of Family-Centered Care.
Association of Maternal-Clinician Ethnic Concordance With Latinx Youth Receipt of Family-Centered Care.
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DOI：
10.1001/jamanetworkopen.2021.33857
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发表时间：
2021-11-01
影响因子：
13.8
通讯作者：
Stimpson JP
中科院分区：
文献类型：
--
作者：
Alberto CK;Kemmick Pintor J;Martínez-Donate A;Tabb LP;Langellier B;Stimpson JP
这项横断面研究探讨了拉丁裔青年的护理质量与母亲和临床医生的种族一致性之间的关联。产科医生种族一致性与青少年接受以家庭为中心的护理相关吗？在这项横断面研究，包括2515拉丁裔青年，产妇临床医生拉丁裔民族一致性被发现有一个积极的平均关联与母亲的报告，他们的年轻人接受以家庭为中心的护理，调整后的产妇特征。这项研究的结果表明，来自代表性不足的少数族裔背景的临床医生有助于缩小美国拉丁裔年轻人之间医疗之家提供的差异。在美国，拉丁裔青年在医疗之家的规定，包括接受以家庭为中心的护理（FCC）方面存在差异。在美国出生的拉丁裔青年中，研究产妇-临床医生种族一致性与接受FCC之间的关系。对2010年1月1日至2017年12月31日的医疗支出小组调查数据进行了横断面二次分析。数据分析于2020年1月6日至2月3日进行。出生于美国、在过去一年中有常规护理来源并使用过护理的拉丁裔青少年（年龄，≤17岁）、他们的拉丁裔母亲（年龄，18-64岁）以及青少年的医疗保健临床医生特征（例如，种族、民族和性别）使用χ2检验和倾向评分匹配方法进行评估。母亲报告他们年轻的医生是否认真听取父母的意见，以父母可以理解的方式解释事情，表现出尊重，并花足够的时间与病人在一起。在研究期间，有2515名美国出生的拉丁裔青年具有连锁的母亲特征; 51.67%（95%CI，48.87%~ 54.45%）青年男性，平均（SD）年龄为8.48（0.17）岁（30.86% [95%CI，28.39%-33.44%]为5 - 9岁），61.53%（95% CI，57.15%~ 65.74%）有公费医疗保险，39.89%（95% CI，32.33%~ 47.89%）的母亲与青少年的医疗保健医生种族一致。我们发现，对于母亲-临床医生种族一致的年轻人，报告FCC的概率显着高于他们在缺乏一致性的情况下的概率：医疗保健临床医生认真听取了父母的意见。（接受治疗的[ATET]的平均治疗效果，5.44%; 95% CI，2.14%-8.74%），以父母可以理解的方式解释事情（ATET，4.82%; 95% CI，1.60%-8.03%），表现出对父母所说的话的尊重（ATET，5.51%; 95% CI，2.58%-8.45%），并与患者共度足够的时间（ATET，5.28%; 95% CI，1.68%-8.88%）。考虑到拉丁裔人口的增加和同时缺乏代表性不足的少数民族医疗保健临床医生，本研究的结果表明，增加来自代表性不足的少数民族背景和种族一致的父母-临床医生关系的临床医生的数量可能有助于减少在美国出生的拉丁裔青年之间接受医疗家庭提供的差异。
This cross-sectional study examines the association between quality of care for Latinx youths and the ethnic concordance of the mothers and clinicians. Is maternal-clinician ethnic concordance associated with youth receipt of family-centered care? In this cross-sectional study including 2515 Latinx youths, maternal-clinician Latinx ethnic concordance was found to have had a positive average association with maternal reports of their youths receiving family-centered care, after adjusting for maternal characteristics. The findings of this study suggest that clinicians from underrepresented minority backgrounds contribute to the attenuation of medical home provision disparities among Latinx youths in the US. Disparities in medical home provisions, including receipt of family-centered care (FCC), have persisted for Latinx youths in the US. To examine the association between maternal-clinician ethnic concordance and receipt of FCC among US-born Latinx youths. A cross-sectional secondary analysis of data from the Medical Expenditure Panel Survey from January 1, 2010, to December 31, 2017, was conducted. Data analysis was performed from January 6 to February 3, 2020. Latinx youths (age, ≤17 years) born in the US who had a usual source of care and used care in the past year, their Latina mothers (age, 18-64 years), and youths’ health care clinician characteristics (eg, race, ethnicity, and sex) were evaluated using χ2 tests and propensity-score matching methods. Maternal reports on whether their youths’ clinician listened carefully to the parent, explained things in a way the parent could understand, showed respect, and spent enough time with the patient. There were 2515 US-born Latinx youths with linked maternal characteristics during the study period; 51.67% (95% CI, 48.87%-54.45%) of the youths were male, mean (SD) age was 8.48 (0.17) years (30.86% [95% CI, 28.39%-33.44%] were between ages 5 and 9 years), 61.53% (95% CI, 57.15%-65.74%) had public insurance coverage, and 39.89% (95% CI, 32.33%-47.89%) had mothers who were ethnically concordant with the youths’ medical care clinician. We found that for youths with maternal-clinician ethnic concordance, the probabilities of reporting FCC were significantly higher than they would have been in the absence of concordance: that the medical care clinician listened carefully to the parent (average treatment effect on the treated [ATET], 5.44%; 95% CI, 2.14%-8.74%), explained things in a way the parent could understand (ATET, 4.82%; 95% CI, 1.60%-8.03%), showed respect for what the parent had to say (ATET, 5.51%; 95% CI, 2.58%-8.45%), and spent enough time with the patient (ATET, 5.28%; 95% CI, 1.68%-8.88%). Given the increase of Latinx populations and the simultaneous shortage of underrepresented minority health care clinicians, the findings of this study suggest that increasing the number of clinicians from underrepresented minority backgrounds and ethnic-concordant parental-clinician relationships may help reduce disparities in receipt of medical home provision among US-born Latinx youths.
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