Legislative: Population-Based Health Datasets – Part 2: Conducting a Study Through the Use of an Interactive Search Feature

Part 1 of this two-part legislative column provided an overview of population-based health databases. The purpose of Part 1 was to review the availability of health datasets as a resource for nurses who need data to advocate for evidence-based interventions and health policy. This column (Part 2) will provide the reader an opportunity to investigate the prevalence of children in the United States (US) who have a medical home, using the interactive search feature provided for the 2007 National Survey of Children’s Health (NSCH). This investigation will demonstrate the ease of using an interactive search feature. Children, especially those living with chronic conditions, benefit from care that is coordinated by a consistent primary care provider. Access to a consistent care provider for medical care is considered an important component of the ‘medical home.’

A medical home, as defined by the American Academy of Pediatrics (AAP), is an ongoing source of care that includes accessibility, continuity, comprehensiveness, a family-centered approach, and coordination, along with compassionate and culturally sensitive services (American Academy of Pediatrics, 2002). Access to, and use of, a medical home have been associated with improved health outcomes for all ages, decreased costs of care, and fewer health disparities between different socio-economic groups (Christakis, Mell, Koepsell, Zimmerman, & Connell, 2001; Gill, Fagan, Townsend, & Mainous, 2005; Inkelas, Newacheck, Olson, Zuckerman, & Schuster, 2008; Kieckhefer, Greek, Joesch, Kim, & Baydar, 2005; Lambrew, DeFriese, Carey, Ricketts, & Biddle, 1996; Palfrey et al., 2004; Starfield & Shi, 2004; Strickland et al., 2009).

In this column (Part 2) we’ll examine the following questions using the 2007 National Survey of Children’s Health database:

1. What percent of U.S. children receive healthcare that meets the American Academy of Pediatrics (AAP) definition of a medical home?
2. Are there differences among race/ethnic groups regarding children who have a medical home?
3. What percent of U.S. children have a personal healthcare provider (providers are defined as a personal doctor or nurse and considered one of the components of the concept of medical home)?
4. Are there differences among race/ethnic groups regarding children who have a personal healthcare provider?

I’ll walk you through the process of getting the data needed to answer these questions:

1. Log onto: http://childhealthdata.org/content/Default.aspx
2. Select: option 2. Quick Start
3. Go to the first box labeled: National Survey of Children’s Health (NSCH), 2003 & 2007
4. You will see 3 drop down boxes. Select ‘2007’ for the first box on the left, ‘Nationwide’ for the middle box, and use the drop down feature to select ‘Health Care Access and Quality’ for the last box on the far right. Click ‘Go’.
5. You will see a list of questions in a box, starting with question 4.1. These questions are from the survey.

   Scroll down using the scroll bar on the right until you find the question: 4.8 Have a medical home (details).

   Click on the circle next to this question (the circle is on the right). The question is now highlighted.

   Take a moment before you find the answer to this question to click on the word (details) and a box will appear. The box contains information regarding how the data for this question were compiled from the survey. This question consists of components of a series of questions asked on the survey. Each component reflects one of the major concepts in the American Academy of Pediatrics’ definition of medical home. These questions were combined since all the components in each individual question are needed to meet the criteria for ‘medical home’ (as defined by the AAP). Now you know how the variable medical home is defined in the survey. Close this box.

6. Because you have already selected question 4.8, click on ‘Next’ (bottom right of page). A table and bar chart should appear. The answer to the first question is: 57.5% of U.S. children receive healthcare that meets the AAP definition of medical home and 42.5% do not have a medical home.
7. To determine if there are racial/ethnic differences to having a medical home, you can compare subgroups.

   Go to the drop down box labeled ‘Compare Subgroups’ and select ‘Race/ethnicity- with Asian (National only)’ from the drop down menu. A new table and bar chart should appear. The table is a cross tabulation of two variables: medical home with race/ethnic groups.

The data reflect that more non-whites than whites do not have a medical home. Hispanic and Black children report higher percents of not having a medical home (61.5% and 55.8%, respectively) than do white children (32%).

We can use the same survey and the same approach to answer questions 3 and 4. These two questions deal with a major component of the medical home concept, namely access to a personal healthcare provider, also known as a personal doctor or nurse. A question specific to a personal doctor or nurse can be found in the NSCH database using similar procedures outlined above. See if you can find the answers to questions 3 and 4:

3. What percent of U.S. children have a personal healthcare provider (defined as a personal doctor of nurse), and considered one of the components of the concept ‘medical home’?

4. Are there differences among race/ethnic groups regarding children who have a personal healthcare provider?

Here are the steps and the answers to questions 3 and 4:

1. Log onto: http://childhealthdata.org/content/Default.aspx
2. Select: option 2. Quick Start
3. Go to the first box labeled: National Survey of Children’s Health (NSCH), 2003 & 2007

   You will see 3 drop down boxes. Select ‘2007’ for the first box on the left, ‘Nationwide’ for the middle box, and use the drop down feature to select ‘Health Care Access and Quality’ for the last box on the far right. Click ‘Go’.

4. You will see a list of questions in a box, starting with question 4.1. These questions are from the survey.

   Scroll down using the scroll bar on your right until you find the question: 4.9 Medical Home Component - Have a personal doctor or nurse (details).

   Click on the circle next to this question (the circle is on the right). The question is now highlighted.

   Take a moment before you find the answer to this question to click on the word (details) and a box will appear. The box contains information regarding how the data for this question were compiled from the survey. The data are from question K4Q04 on the survey. If you click on this question (listed under the heading Survey Item(s) at the top of the box), another box appears that contains the actual question from the survey that was asked to parents/guardians. Close this box.

5. Because you have already selected question 4.9, click on ‘Next’ (bottom right of page). A table and bar chart should appear. The answer to the first question is: 92.2% of U.S. children have a personal doctor or nurse and 7.8% do not.
6. To determine if there are racial/ethnic differences, you can compare subgroups.

   Go to the drop down box labeled ‘Compare Subgroups’ and select ‘Race/ethnicity- with Asian (National only)’ from the drop down menu. A new table and bar chart should appear. The table is a cross tabulation of the medical home with race/ethnic groups.

The data reflect that more non-whites than whites do not have a personal doctor or nurse.  Hispanic and Black children report higher percents of not having a personal doctor or nurse (14.2% and 11.2%, respectfully) than white children (4.5%).

Additional analyses could be done on a state level by selecting a specific state in the appropriate drop down menu. For example, one way to select a specific state is:

1. Log onto: http://childhealthdata.org/content/Default.aspx
2. Select: option 2. Quick Start
3. Go to the first box labeled: National Survey of Children’s Health (NSCH), 2003 & 2007

   You will see 3 drop down boxes. Select the year you want to examine (either ‘2003’ or ‘2007’) from the first box on the left. Instead of selecting ‘Nationwide’ for the middle box, use the drop down feature to select a specific state. Then use the drop down feature in the last box to select a category from the survey. Click ‘Go’ to find the state specific data.

This interactive site also contains data from the 2001 and the 2005/06 National Survey of Children with Special Health Care Needs (CSHCN). One can also examine the CSHCN site to describe the number of children living with chronic conditions who do not have a medical home and determine if there are differences based on race/ethnicity. Both surveys provide an opportunity to examine many health indicators specific to children and their families.

Not all population-based health databases have interactive websites for initial data analysis. While a majority of the databases are easily accessed through government websites and at no charge, the researcher will need to use statistical software programs that are designed to handle weighted samples. Most analyses of this type are conducted by a group of researchers and include the expertise of a statistical software programmer and biostatistician. Details pertaining to data analyses are addressed in Part 1 of this column. Hopefully an increasing number of government-funded health datasets will soon include interactive websites to increase accessibility to data needed by healthcare professionals and consumers engaged in health advocacy efforts. 

Author

Mary Beth Zeni, ScD, MSN, RN
Email: zenim@ccf.org

Dr. Zeni is a senior nurse researcher at Cleveland Clinic, Cleveland, Ohio. Dr. Zeni completed a doctorate at the University of Pittsburgh Graduate School Of Public Health in 1993. She received her MSN in parent-child nursing from Marquette University (1982) and has served as a clinical nurse specialist at various regional perinatal centers. Dr. Zeni has been a researcher in the public and private sectors since 1992. Her research has focused on the evaluation of HIV prevention and maternal-child health programs. Previous publications, research, and presentations have included original analyses of the National Survey of Children’s Health with a focus on children’s access to medical care related to health insurance coverage. She was a graduate faculty member at University of Pittsburgh School of Nursing and at Florida State University College of Nursing (Tallahassee, FL); she currently has faculty appointments at Ursuline College and Case Western Reserve University (Cleveland, Ohio) and the University of Akron (Ohio).