Disparities in Shared Decision Making and Service Receipt AmongChildren With Special Health Care Needs and Developmental Delay: A NationalSurvey Analysis

摘要

Shared decision making (SDM) is associated with increased service satisfactionamong pediatric patients. Our objective was to examine the association betweenSDM and service use experiences across racial/ethnic child groups. Thissecondary data analysis used the 2009-2010 National Survey of Children withSpecial Health Care Needs (CSHCN) and 2011 Pathways to Diagnosis and ServicesSurvey. We used a rank-and-replace matching approach consistent with Instituteof Medicine recommendations for health disparities research. We included CSHCNaged 6 to 17 years. The exposure of interest was parents of CSHCN reportingengagement in SDM with clinicians. There were 4032 CSHCN included in analysis.CSHCNs experiencing SDM had a 16% higher probability of reporting service usecompared to those not experiencing it (95% CI, 14.24-19.42). Black childrenexperiencing SDM reported seeing all needed care providers at a lower rate thanwhites (79% and 87.6% respectively; 95% CI, -14.05-3.27). The benefit of SDMover not experiencing it for blacks was 12.2% less than for whites for theoutcome of seeing all needed care providers. For the outcome of receiving allneeded treatments and services, the SDM benefit was 9.1% lower for Hispanicscompared with whites. SDM can improve service experiences but implementationflexibility may be needed.