April 1, 2022

Efforts to drive more equitable health outcomes in primary care depend on an inclusive and data-informed understanding of who is able to access and utilize care services effectively, and where structural barriers may inhibit patients from achieving their full health potential.

According to a new study conducted by a team of researchers from Oregon Health and Science University (OHSU) and OCHIN, Latino children who prefer to receive care in Spanish were most likely to visit Community Health Centers (CHCs) for preventive and acute asthma care (and less likely to visit the Emergency department), while Black children with asthma accessed CHCs less than white children. Not only was this pattern of low clinic utilization among Black children accompanied by more frequent emergency department visits compared to other groups, but it also suggests factors beyond affordability may influence current disparities in health care utilization by some communities of color.

The new study, funded by the National Institute on Minority Health and Health Disparities at the National Institutes of Health and published in Annals of Family Medicine, was the first to investigate the long-term patterns of asthma care utilization by race and ethnicity across multiple care settings. The research team, led by OHSU and first author Jorge Kaufmann, ND, MS, analyzed the electronic health record data of more than 40,000 children in 18 states to compare acute asthma-care sought within CHCs and hospital emergency departments over a seven-year period before COVID-19.

Published just ahead of National Minority Health Month, additional observations and potential implications from the study include:

• Most children in the collective sample experienced a wealth gap, with Black children experiencing a gap most frequently.
• The finding that Black children are less likely to utilize CHC’s but are more likely to use emergency departments for asthma may be explained, in part, by the wealth gap; these children may experience greater financial instability and/or the inability for a guardian to leave work or fill prescription medication, resulting in more severe symptoms that could warrant emergency care.
• CHCs in this study may have more provider/staff resources available to offer culturally and linguistically tailored care for Latino patients and provide a level of cultural affinity not experienced by Black patients utilizing these same clinics.

 “Our findings emphasize the need to look deeper than cost and access to uncover other structural drivers of inequity and understand how our health systems may deliver care more or less effectively to different populations,” said senior author John Heintzman, MD, MPH, OCHIN’s lead clinical scientist and OHSU Principal Investigator. “These ideas are especially pertinent as we commemorate National Minority Health Month in April. Differences in health for Black patients and other communities of color are systemic, avoidable, and unjust, and we must continue our research in this area to learn how to close these gaps.”

The study was conducted with the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) Clinical Research Network (CRN). ADVANCE is a multicenter research network led by OCHIN in partnership with Fenway Health, Health Choice Network, and OHSU. ADVANCE is funded through the Patient Centered Outcomes Research Institute (PCORI) and is a member of the National Patient-Centered Clinical Research Network (PCORnet).

To view the National Institute on Minority Health and Health Disparities announcement about the study, read their press release.