Promoting child health equity: family-centered care coordination is just one piece of the puzzle.

In their report in this month’s issue of Pediatrics, Toomey et al analyzed data from the National Survey of Children’s Health related to parental rating of their children’s receipt of care coordination. The authors found that 41% of all parents, and 72% of parents of children with special health care needs, reported that their child needed some type of care coordination. However, almost one-third of those reporting the need for care coordination perceived their needs to be unmet. Not surprisingly, Latino and African American children, low income, uninsured children and those with public insurance, nonEnglish speaking-families, single-parent households, children without a personal healthcare provider, and children and youth with special health care needs were more likely to report ineffective care coordination. In the multivariable analyses, receipt of culturally competent, family-centered care mitigated the racial/ethnic disparities in care coordination. The study demonstrates that family-centered care, a central characteristic of which is cultural sensitivity and competency, helps to mitigate racial/ethnic disparities in the receipt of care coordination. Cultural competency is an emerging field in medical practice and medical education, and it is increasingly recognized as critically important to effective health care communication. Improvement in the quality of primary care, structured around the medical home, must include improving the interpersonal aspects of care, cross-cultural interactions and communication, and increasing patients’ involvement in care. All providers should be trained to improve their cross-cultural interpersonal interactions to engage patients from all racial and ethnic backgrounds equally. Cultural competency training should be emphasized in undergraduate and graduate medical education as a core aspect of medical history taking and communication. Culturally effective communication with minority children and families, and/or families from classes or cultures different from our own, is a critical step toward providing effective care coordination in a comprehensive medical home, thereby promoting health equity and reducing health and health care disparities. Importantly, however, the multivariable analyses from this study also demonstrated that having a regular provider and experiencing familycentered care did not eliminate disparities associated with social and environmental determinants of health (eg, health status, family structure, or insurance status). Moreover, the authors of the study also examined the rating of care coordination by families of children with different types of conditions. Those with brain injuries and mental health conditions reported higher rates of unmet needs for care coordination than those with physical health conditions. Although studies have revealed that care coordination, as an element of the AUTHORS: David L. Wood, MD, MPH, and Jeffrey L. Goldhagen, MD, MPH