Friedberg Mark W, Coltin Kathryn L, Safran Dana Gelb, Dresser Marguerite, Schneider Eric C
Division of General Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA.
Arch Intern Med. 2010 Jun 14;170(11):938-44. doi: 10.1001/archinternmed.2010.110.
Under current medical home proposals, primary care practices using specific structural capabilities will receive enhanced payments. Some practices disproportionately serve sociodemographically vulnerable neighborhoods. If these practices lack medical home capabilities, their ineligibility for enhanced payments could worsen disparities in care.
Via survey, 308 Massachusetts primary care practices reported their use of 13 structural capabilities commonly included in medical home proposals. Using geocoded US Census data, we constructed racial/ethnic minority and economic disadvantage indices to describe the neighborhood served by each practice. We compared the structural capabilities of "disproportionate-share" practices (those in the most sociodemographically vulnerable quintile on each index) and others.
Racial/ethnic disproportionate-share practices were more likely than others to have staff assisting patient self-management (69% vs 55%; P = .003), on-site language interpreters (54% vs 26%; P < .001), multilingual clinicians (80% vs 51%; P < .001), and multifunctional electronic health records (48% vs 29%; P = .01). Similarly, economic disproportionate-share practices were more likely than others to have physician awareness of patient experience ratings (73% vs 65%; P = .03), on-site language interpreters (56% vs 25%; P < .001), multilingual clinicians (78% vs 51%; P < .001), and multifunctional electronic health records (40% vs 31%; P = .03). Disproportionate-share practices were larger than others. After adjustment for practice size, only language capabilities continued to have statistically significant relationships with disproportionate-share status.
Contrary to expectations, primary care practices serving sociodemographically vulnerable neighborhoods were more likely than other practices to have structural capabilities commonly included in medical home proposals. Payments tied to these capabilities may aid practices serving vulnerable populations.
根据当前的医疗之家提案，采用特定结构能力的基层医疗服务机构将获得额外报酬。一些机构不成比例地服务于社会人口统计学上弱势的社区。如果这些机构缺乏医疗之家的能力，它们没有资格获得额外报酬可能会加剧医疗服务的差距。
通过调查，308家马萨诸塞州的基层医疗服务机构报告了它们对医疗之家提案中通常包含的13种结构能力的使用情况。利用美国人口普查的地理编码数据，我们构建了种族/族裔少数群体和经济劣势指数，以描述每家机构所服务的社区。我们比较了“高比例份额”机构（在每个指数中处于社会人口统计学上最弱势的五分之一的机构）和其他机构的结构能力。
种族/族裔高比例份额机构比其他机构更有可能配备协助患者自我管理的工作人员（69%对55%；P = 0.003）、现场语言口译员（54%对26%；P < 0.001）、多语言临床医生（80%对51%；P < 0.001）以及多功能电子健康记录（48%对29%；P = 0.01）。同样，经济高比例份额机构比其他机构更有可能让医生了解患者体验评分（73%对65%；P = 0.03）、配备现场语言口译员（56%对25%；P < 0.001）、多语言临床医生（78%对51%；P < 0.001）以及多功能电子健康记录（40%对31%；P = 0.03）。高比例份额机构规模比其他机构更大。在对机构规模进行调整后，只有语言能力与高比例份额状态继续存在统计学上的显著关系。
与预期相反，服务于社会人口统计学上弱势社区的基层医疗服务机构比其他机构更有可能具备医疗之家提案中通常包含的结构能力。与这些能力挂钩的报酬可能有助于服务弱势群体的机构。
