Hicks LeRoi S, O'Malley A James, Lieu Tracy A, Keegan Thomas, McNeil Barbara J, Guadagnoli Edward, Landon Bruce E
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
Arch Intern Med. 2010 Feb 8;170(3):279-86. doi: 10.1001/archinternmed.2010.493.
The Health Resources and Services Administration Health Disparities Collaboratives (HDCs) were developed to improve care for chronic medical conditions in community health centers (CHCs).
We examined whether HDCs reduced disparities in quality by race/ethnicity or insurance status in CHCs nationally. We performed a controlled preintervention/postintervention study of 44 CHCs participating in HDCs for asthma, diabetes mellitus, or hypertension and 20 "external" control CHCs that had not participated. Each intervention center also served as an "internal" control for another condition. For each condition, we created an overall quality score, defined disparities in care as the differences in care between racial/ethnic groups and insurance groups, and examined changes in disparity through a series of hierarchical models using a 3-way interaction term among period, patient characteristics of interest, and treatment group.
Overall, HDCs had little effect on disparities in composite measures for asthma, diabetes, and hypertension. For asthma care, collaborative centers had a baseline Hispanic-white disparity of 6.5%, which changed to a higher quality of recommended care for Hispanic patients over white patients by 0.8%, resulting in a significantly reduced Hispanic-white disparity compared with the change in disparity seen in external controls (P = .04). There were no other improvements in racial/ethnic or insurance disparities for any other conditions.
Although HDCs are known to improve quality of care in CHCs, they had minimal effect on racial/ethnic and insurance disparities. In addition to targeting improvement in overall quality, future initiatives should include activities aimed at disparity reduction as an outcome.
卫生资源与服务管理局健康差异协作项目（HDCs）旨在改善社区卫生中心（CHCs）对慢性疾病的护理。
我们研究了HDCs是否减少了全国社区卫生中心中因种族/民族或保险状况导致的护理质量差异。我们对44家参与哮喘、糖尿病或高血压HDCs项目的社区卫生中心以及20家未参与的“外部”对照社区卫生中心进行了干预前/干预后对照研究。每个干预中心也作为另一种疾病的“内部”对照。对于每种疾病，我们创建了一个总体质量得分，将护理差异定义为种族/民族群体和保险群体之间护理的差异，并通过一系列分层模型，使用时期、感兴趣的患者特征和治疗组之间的三向交互项来研究差异的变化。
总体而言，HDCs对哮喘、糖尿病和高血压综合指标的差异影响不大。对于哮喘护理，协作中心西班牙裔与白人的基线差异为6.5%，转变为西班牙裔患者比白人患者获得推荐护理的质量提高了0.8%，与外部对照中差异的变化相比，西班牙裔与白人的差异显著降低（P = .04）。对于任何其他疾病，种族/民族或保险差异没有其他改善。
尽管已知HDCs可改善社区卫生中心的护理质量，但它们对种族/民族和保险差异的影响微乎其微。除了致力于提高总体质量外，未来的举措应将减少差异作为一项成果纳入活动中。
