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Disparities in Shared Decision Making and Service Receipt Among Children With Special Health Care Needs and
Monica Perez Jolles1, Leah L Zullig2, Pey-Jiuan Lee1
1University of Southern California, Los Angeles, CA, USA.
Insights
Shared decision making (SDM) improves pediatric healthcare experiences. However, benefits for Black and Hispanic children in accessing care were less than for white children, suggesting a need for flexible implementation.
Area of Science:
- Health Services Research
- Pediatric Health
- Health Disparities
Background:
- Shared decision making (SDM) is linked to higher patient satisfaction.
- Understanding SDM's impact across racial/ethnic groups is crucial for equitable care.
Purpose of the Study:
- To analyze the association between SDM and healthcare service use experiences in children with special healthcare needs (CSHCN) across different racial/ethnic groups.
- To identify potential disparities in SDM benefits.
Main Methods:
- Secondary data analysis of the 2009-2010 CSHCN and 2011 Pathways to Diagnosis and Services Surveys.
- Included 4032 CSHCN aged 6-17 years, analyzing parental reports of SDM engagement.
- Employed a rank-and-replace matching approach for health disparities research.
Main Results:
- Children experiencing SDM showed a 16% higher probability of reporting service use.
- Black children receiving SDM had lower rates of seeing all needed providers compared to white children (79% vs. 87.6%).
- SDM benefits for accessing care were less pronounced for Black and Hispanic children compared to white children.
Conclusions:
- While SDM generally improves service experiences for CSHCN, its benefits are not uniform across racial/ethnic groups.
- Implementation flexibility is necessary to ensure equitable SDM benefits for all children.
- Further research is needed to address disparities in SDM effectiveness.
Abstract:
Shared decision making (SDM) is associated with increased service satisfaction among pediatric patients. Our objective was to examine the association between SDM and service use experiences across racial/ethnic child groups. This secondary data analysis used the 2009-2010 National Survey of Children with Special Health Care Needs (CSHCN) and 2011 Pathways to Diagnosis and Services Survey. We used a rank-and-replace matching approach consistent with Institute of Medicine recommendations for health disparities research. We included CSHCN aged 6 to 17 years. The exposure of interest was parents of CSHCN reporting engagement in SDM with clinicians. There were 4032 CSHCN included in analysis. CSHCNs experiencing SDM had a 16% higher probability of reporting service use compared to those not experiencing it (95% CI, 14.24-19.42). Black children experiencing SDM reported seeing all needed care providers at a lower rate than whites (79% and 87.6% respectively; 95% CI, -14.05-3.27). The benefit of SDM over not experiencing it for blacks was 12.2% less than for whites for the outcome of seeing all needed care providers. For the outcome of receiving all needed treatments and services, the SDM benefit was 9.1% lower for Hispanics compared with whites. SDM can improve service experiences but implementation flexibility may be needed.
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