医疗保险管理式医疗中的医疗质量趋势及种族差异

Trends in the quality of care and racial disparities in Medicare managed care.

作者信息

Trivedi Amal N, Zaslavsky Alan M, Schneider Eric C, Ayanian John Z

机构信息

Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, USA.

出版信息

N Engl J Med. 2005 Aug 18;353(7):692-700. doi: 10.1056/NEJMsa051207.

DOI:10.1056/NEJMsa051207

PMID:16107622

Abstract

BACKGROUND

Since 1997, all managed-care plans administered by Medicare have reported on quality-of-care measures from the Health Plan Employer Data and Information Set (HEDIS). Studies of early data found that blacks received care that was of lower quality than that received by whites. In this study, we assessed changes over time in the overall quality of care and in the magnitude of racial disparities in nine measures of clinical performance.

METHODS

In order to compare the quality of care for elderly white and black beneficiaries enrolled in Medicare managed-care plans who were eligible for at least one of nine HEDIS measures, we analyzed 1.8 million individual-level observations from 183 health plans from 1997 to 2003. For each measure, we assessed whether the magnitude of the racial disparity had changed over time with the use of multivariable models that adjusted for the age, sex, health plan, Medicaid eligibility, and socioeconomic position of beneficiaries on the basis of their area of residence.

RESULTS

During the seven-year study period, clinical performance improved on all measures for both white enrollees and black enrollees (P<0.001). The gap between white beneficiaries and black beneficiaries narrowed for seven HEDIS measures (P<0.01). However, racial disparities did not decrease for glucose control among patients with diabetes (increasing from 4 percent to 7 percent, P<0.001) or for cholesterol control among patients with cardiovascular disorders (increasing from 14 percent to 17 percent; change not significant, P=0.72).

CONCLUSIONS

The measured quality of care for elderly Medicare beneficiaries in managed-care plans improved substantially from 1997 to 2003. Racial disparities declined for most, but not all, HEDIS measures we studied. Future research should examine factors that contributed to the narrowing of racial disparities on some measures and focus on interventions to eliminate persistent disparities in the quality of care.

摘要

背景

自1997年以来，医疗保险管理的所有管理式医疗计划都根据健康计划雇主数据与信息集（HEDIS）报告医疗质量指标。对早期数据的研究发现，黑人接受的医疗服务质量低于白人。在本研究中，我们评估了九项临床绩效指标在医疗服务总体质量和种族差异程度方面随时间的变化。

方法

为了比较参加医疗保险管理式医疗计划且符合九项HEDIS指标中至少一项的老年白人和黑人受益人的医疗服务质量，我们分析了1997年至2003年来自183个健康计划的180万份个体水平观察数据。对于每项指标，我们使用多变量模型评估种族差异程度是否随时间发生变化，该模型根据受益人的居住地区对其年龄、性别、健康计划、医疗补助资格和社会经济地位进行了调整。

结果

在为期七年的研究期间，白人参保者和黑人参保者在所有指标上的临床绩效均有所改善（P<0.001）。七项HEDIS指标中，白人受益人和黑人受益人的差距缩小（P<0.01）。然而，糖尿病患者的血糖控制或心血管疾病患者的胆固醇控制方面的种族差异并未减少（分别从4%增至7%，P<0.001；从14%增至17%，变化不显著，P=0.72）。