Disparities in Shared Decision Making and Service Receipt Among Children With Special Health Care Needs and Developmental Delay: A National Survey Analysis. (June 2020)

• Record Type: Journal Article
• Authors: Perez Jolles, Monica; Zullig, Leah L.; Lee, Pey-Jiuan; Kolhatkar, Gauri
• Is Part Of: Journal of primary care & community health. Volume 11(2020)
• Publication Date: 2020-06
• Subjects: shared decision making -- racial and ethnic health care disparities -- service experiences -- patient-centered care -- children with special health care needs; Primary health care -- Periodicals; Primary health care -- United States -- Periodicals; Community health services -- Periodicals; Community health services -- United States -- Periodicals; 362.12
• DOI: 10.1177/2150132720924588
• Languages: English
• ISSNs: 2150-1319

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.