医疗保险管理式医疗参保者护理质量中的种族差异。

Racial disparities in the quality of care for enrollees in medicare managed care.

作者信息

Schneider Eric C, Zaslavsky Alan M, Epstein Arnold M

机构信息

Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115,USA.

出版信息

JAMA. 2002 Mar 13;287(10):1288-94. doi: 10.1001/jama.287.10.1288.

DOI:10.1001/jama.287.10.1288

PMID:11886320

Abstract

CONTEXT

Substantial racial disparities in the use of some health services exist; however, much less is known about racial disparities in the quality of care.

OBJECTIVE

To assess racial disparities in the quality of care for enrollees in Medicare managed care health plans.

DESIGN AND SETTING

Observational study, using the 1998 Health Plan Employer Data and Information Set (HEDIS), which summarized performance in calendar year 1997 for 4 measures of quality of care (breast cancer screening, eye examinations for patients with diabetes, beta-blocker use after myocardial infarction, and follow-up after hospitalization for mental illness).

PARTICIPANTS

A total of 305 574 (7.7%) beneficiaries who were enrolled in Medicare managed care health plans had data for at least 1 of the 4 HEDIS measures and were aged 65 years or older.

MAIN OUTCOME MEASURES

Rates of breast cancer screening, eye examinations for patients with diabetes, beta-blocker use after myocardial infarction, and follow-up after hospitalization for mental illness.

RESULTS

Blacks were less likely than whites to receive breast cancer screening (62.9% vs 70.9%; P<.001), eye examinations for patients with diabetes (43.6% vs 50.4%; P =.02), beta-blocker medication after myocardial infarction (64.1% vs 73.8%; P<.005), and follow-up after hospitalization for mental illness (33.2 vs 54.0%; P<.001). After adjustment for potential confounding factors, racial disparities were still statistically significant for eye examinations for patients with diabetes, beta-blocker use after myocardial infarction, and follow-up after hospitalization for mental illness.

CONCLUSION

Among Medicare beneficiaries enrolled in managed care health plans, blacks received poorer quality of care than whites.

摘要

背景

在一些医疗服务的使用方面存在显著的种族差异；然而，对于医疗质量方面的种族差异了解得要少得多。

目的

评估医疗保险管理式医疗保健计划参保者在医疗质量方面的种族差异。

设计与环境

观察性研究，使用1998年健康计划雇主数据与信息集（HEDIS），该数据集总结了1997年日历年4项医疗质量指标（乳腺癌筛查、糖尿病患者眼部检查、心肌梗死后β受体阻滞剂的使用以及精神疾病住院后的随访）的表现。

参与者

共有305574名（7.7%）参加医疗保险管理式医疗保健计划的受益人拥有4项HEDIS指标中至少1项的数据，且年龄在65岁及以上。

主要结局指标

乳腺癌筛查率、糖尿病患者眼部检查率、心肌梗死后β受体阻滞剂的使用率以及精神疾病住院后的随访率。

结果

黑人接受乳腺癌筛查的可能性低于白人（62.9%对70.9%；P<0.001），糖尿病患者接受眼部检查的比例低于白人（43.6%对50.4%；P = 0.02），心肌梗死后使用β受体阻滞剂药物的比例低于白人（64.1%对73.8%；P<0.005），精神疾病住院后的随访率低于白人（33.2对54.0%；P<0.001）。在对潜在混杂因素进行调整后，糖尿病患者眼部检查、心肌梗死后β受体阻滞剂的使用以及精神疾病住院后的随访方面的种族差异在统计学上仍然显著。