TY - JOUR
T1 - DBP Evaluations in DBPNet Sites
T2 - Is Race/Ethnicity a Significant Factor in Care?
AU - Augustyn, Marilyn
AU - Silver, Ellen Johnson
AU - Blum, Nathan
AU - High, Pamela
AU - Roizen, Nancy
AU - Stein, Ruth E.K.
N1 - Funding Information:
DBPNet is supported by cooperative agreement UA3MC20218 from the Maternal and Child Health Bureau, Health Resources and Services Administration of the US Department of Health and Human Services. This content and conclusions are those of the authors and should not be construed as the official position or policy of nor should any endorsements be inferred by HRSA, HHS, or the US government. The authors wish to acknowledge the participation of DBPs practicing at the sites who contributed data and support to this study and the members of the DBP Steering Committee not listed as authors who contributed to the development and implementation of this study, including William Barbaresi, MD, Children’s Hospital Boston; Jill Fussell, MD, University of Arkansas for Medical Sciences; Robin Hansen, MD, University of California-Davis MIND Institute; Heidi Feldman, MD, PhD, Lucile Packard Children’s Hospital; Susan Wiley, MD, Cincinnati Children’s Hospital Medical Center; Carol Weitzman, MD, Yale-New Haven Children’s Hospital; and Mark Wolraich, MD, University of Oklahoma Health Sciences Center. Study data were managed using REDCap electronic data capture tools hosted at The Children’s Hospital of Philadelphia. REDCap (Research Electronic Data Capture) is a secure, web-based application designed to support data capture for research studies, providing (1) an intuitive interface for validated data entry; (2) audit trails for tracking data manipulation and export procedures; (3) automated export procedures for seamless data downloads to common statistical packages; and (4) procedures for importing data from external sources.
Funding Information:
From the *Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, MA; †Division of Academic General Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine/Children’s Hospital at Montefiore, New York, NY; ‡Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; §Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Alpert Medical School, Brown University, Providence RI; \Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH; ¶Division of Developmental Medicine, Department of Pediatrics, Albert Einstein College of Medicine/Children’s Hospital at Montefiore, New York, NY. Received January 2018; accepted June 2019. DBPNet is supported by cooperative agreement UA3MC20218 from the Maternal and Child Health Bureau, Health Resources and Services Administration of the US Department of Health and Human Services. This content and conclusions are those of the authors and should not be construed as the official position or policy of nor should any endorsements be inferred by HRSA, HHS, or the US government.
Publisher Copyright:
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - 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 5 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 5 0.02), ophthalmology evaluations (8.7% vs 3.4%, p 5 0.03), and psychopharmacologic evaluations (19.1% vs 9.7%, p 5 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.
AB - 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 5 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 5 0.02), ophthalmology evaluations (8.7% vs 3.4%, p 5 0.03), and psychopharmacologic evaluations (19.1% vs 9.7%, p 5 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.
KW - DBP evaluation
KW - race
UR - http://www.scopus.com/inward/record.url?scp=85071283296&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85071283296&partnerID=8YFLogxK
U2 - 10.1097/DBP.0000000000000710
DO - 10.1097/DBP.0000000000000710
M3 - Article
C2 - 31335580
AN - SCOPUS:85071283296
SN - 0196-206X
VL - 41
SP - 23
EP - 30
JO - Journal of Developmental and Behavioral Pediatrics
JF - Journal of Developmental and Behavioral Pediatrics
IS - 1
ER -
