The role of care location in diagnosis and treatment of pediatric psychosocial conditions.
Racial differences in diagnosis and treatment of psychosocial conditions have been well documented. It is unclear if these differences represent variance in prevalence or are actually disparities in care driven by social factors, income-related differences, or differences in the actual location of care. We used 4 years of National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Surveys as source for data on visits to private offices and hospital-based clinics. In addition to the standard practice of combining surveys across years, we used a "supersurvey" approach to combining the 2 distinct surveys. In our roughly 20,000 sampled visits, we confirmed the higher concentration of low-income children in visits to hospital-based clinics (p <.001), but saw no significant racial difference (p =.104). After controlling for race, income, and other demographics, we found that visits to hospital-based clinics were significantly more likely to include a diagnosis of depression (odds ratio [OR], 4.4; p =.011), but that there was no statistically significant difference in other psychosocial diagnoses. Once a diagnosis is made, there is no evidence of differences in treatment or follow-up between office-based or hospital clinic-based providers. Our analyses support previously gathered evidence for differences in economic status of the clientele of private offices and hospital-based clinics. We surprisingly found visits to clinics to be more likely to include a depression diagnosis, but this may be an artifact of the data reflecting visits rather than patients. We found no evidence that treatment or follow-up is different for the disadvantaged who use clinics rather than private offices.