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DBP Evaluations in DBPNet Sites: Is Race/Ethnicity a Significant Factor in Care?
Marilyn Augustyn1, Ellen Johnson Silver2, Nathan Blum3
1Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, MA.
Insights
This study found minimal differences in wait times, referral reasons, evaluations, or diagnoses between non-Hispanic white (NHW) and nonwhite (NW) children in developmental behavioral pediatrician (DBP) evaluations. Socioeconomic factors were considered in the analysis.
Area of Science:
- Pediatrics
- Developmental Behavioral Pediatrics
- Health Disparities Research
Background:
- Developmental Behavioral Pediatric (DBP) evaluations are crucial for identifying and managing neurodevelopmental and behavioral disorders in children.
- Understanding potential racial and ethnic disparities in healthcare access and outcomes is essential for equitable care.
- Socioeconomic factors may influence healthcare experiences and outcomes, potentially mediating racial or ethnic differences.
Purpose of the Study:
- To investigate disparities in referral questions, evaluation procedures, and diagnoses between non-Hispanic white (NHW) and nonwhite (NW) children undergoing DBP evaluations.
- To assess the role of socioeconomic factors in any observed differences between NHW and NW children in DBP evaluations.
Main Methods:
- An observational study analyzed survey data from 56 developmental behavioral pediatricians across 12 academic medical centers.
- Mixed-model logistic and linear regression analyses were employed to compare NHW and NW children on referral concerns, evaluation procedures, and diagnoses.
- Socioeconomic variables, including insurance type, parent education, and home language, were controlled for in the analyses.
Main Results:
- No significant differences were found in wait times to care between NHW and NW children (20.4 vs. 20.5 weeks).
- Referral reasons were largely similar, with sleep problems being more frequent among NHW children.
- While evaluations were generally similar, NHW children were more likely to receive genetic testing, ophthalmology evaluations, and psychopharmacologic evaluations compared to NW children.
Conclusions:
- This study indicates minimal racial or ethnic disparities in wait times, referral reasons, workup, or diagnoses for initial DBP evaluations when socioeconomic factors are considered.
- Despite the lack of direct disparities in this study, underlying socioeconomic factors may still contribute to broader racial/ethnic inequities in child health.
- Future care models and protocols for underserved communities should consider these socioeconomic factors to promote equitable DBP services.
Objective:
To examine whether there are differences between non-Hispanic white (NHW) and nonwhite (NW) children in referral questions, evaluations, and diagnoses during developmental behavioral pediatrician (DBP) evaluations at academic medical centers and the potential role of socioeconomic factors in any disparities noted.
Design/Methods:
This observational study used survey data from 56 DBPs at 12 sites participating in DBPNet. Child race and ethnicity were obtained from DBP report. Mixed-model logistic and linear regression analyses controlling for site, provider, and socioeconomic proxy variables (insurance type, parent education, and language spoken at home) were used to compare groups on referral concerns, evaluation procedures, and diagnoses.
Results:
Among the patients evaluated, 349 were NHW, 406 were NW (187 Hispanic, 135 black, 58 Asian/Pacific Islander, and 26 other/mixed), and 29 were missing race/ethnicity data. The mean waiting time controlling for site and provider was 20.4 weeks for NHW children and 20.5 weeks for NW children. Reasons for referral were similar in the NWH and NW groups, with only sleep problem concerns being more frequent among NHW children (9.2% vs 3.4% NW, p = 0.01). Patients also had similar evaluations in the 2 groups; the only differences found were that more NHW than NW children had genetic testing (33.1% vs 19.3%, p = 0.02), ophthalmology evaluations (8.7% vs 3.4%, p = 0.03), and psychopharmacologic evaluations (19.1% vs 9.7%, p = 0.008). Numbers and types of diagnoses did not vary by race/ethnicity.
Conclusion:
This study suggests little inequality between NHW and NW children in wait time to care, reasons for referral, workup, or final diagnosis for initial DBP evaluation at these 12 academic DBP centers when socioeconomic factors are considered. Nevertheless, because differences in these related factors may be mechanisms through which racial/ethnic disparities can arise, it will be important to consider them in planning models and care protocols for underserved communities.
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