Lebrun Lydie A, Shi Leiyu, Zhu Jinsheng, Sharma Ravi, Sripipatana Alek, Hayashi A Seiji, Daly Charles A, Ngo-Metzger Quyen
Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland, USA.
J Ambul Care Manage. 2013 Jan-Mar;36(1):24-34. doi: 10.1097/JAC.0b013e3182473523.
More than 1100 federally funded health centers provide primary and preventive care to about 20 million underserved patients in the United States. Since 2008, the Health Resources and Services Administration has implemented a clinical quality improvement initiative to measure and evaluate the quality of care across all health centers. We assessed racial/ethnic disparities in clinical quality among US health centers, and examined whether performance on quality measures varied across 3 health center characteristics. National data came from the 2009 Uniform Data System. We examined performance across 3 indicators of clinical quality: poorly controlled hypertension among adult patients, poorly controlled diabetes among adult patients, and low birth weight among newborns. We compared results for each measure across racial/ethnic groups, as well as across 3 health center characteristics: health center patient volume, duration of health center funding, and extent of managed care penetration. Non-Hispanic Asian patients had the best results among racial/ethnic groups for 2 of the 3 measures examined: lowest rates of poorly controlled diabetes (26%) and hypertension (34%). Hispanics/Latinos had similar rates of poor hypertension control compared with non-Hispanic whites (38% for both), and lower rates of low birth weight (8% vs 10%). Poor diabetes control was more prevalent among Hispanic/Latino patients than non-Hispanic white patients, but the absolute difference was small (5 percentage points). Non-Hispanic black/African American patients had statistically worse outcomes than non-Hispanic white patients, but the absolute differences were also small (2-6 percentage points, depending on outcome). Health centers with larger patient volume fared better than their counterparts with smaller volume for all racial/ethnic groups. For Hispanic/Latino patients, more established health centers compared favorably to new health centers for all 3 outcomes. Health centers with some managed care penetration did better for diabetes and hypertension control relative to health centers without managed care penetration. Compared with national rates, health centers report minimal racial/ethnic disparities in clinical outcomes. Health center characteristics are also associated with clinical outcomes. More research is needed to determine the nature of disparities after accounting for health center patient, provider, and institutional characteristics.
1100多家由联邦政府资助的医疗中心为美国约2000万未得到充分医疗服务的患者提供初级和预防性医疗服务。自2008年以来，卫生资源与服务管理局实施了一项临床质量改进计划，以衡量和评估所有医疗中心的医疗质量。我们评估了美国医疗中心临床质量方面的种族/族裔差异，并研究了质量指标的表现是否因3个医疗中心特征而异。国家数据来自2009年统一数据系统。我们考察了临床质量的3个指标的表现：成年患者中控制不佳的高血压、成年患者中控制不佳的糖尿病以及新生儿低出生体重。我们比较了各指标在不同种族/族裔群体之间以及3个医疗中心特征（医疗中心患者数量、医疗中心资金持续时间和管理式医疗渗透程度）之间的结果。在接受检查的3项指标中的2项上，非西班牙裔亚裔患者在种族/族裔群体中结果最佳：控制不佳的糖尿病发生率最低（26%），高血压发生率最低（34%）。西班牙裔/拉丁裔患者的高血压控制不佳率与非西班牙裔白人相似（均为38%），低出生体重率较低（8%对10%）。西班牙裔/拉丁裔患者中糖尿病控制不佳的情况比非西班牙裔白人患者更普遍，但绝对差异很小（5个百分点）。非西班牙裔黑人/非裔美国患者的统计结果比非西班牙裔白人患者差，但绝对差异也很小（2 - 6个百分点，取决于结果）。所有种族/族裔群体中，患者数量较多的医疗中心比患者数量较少的同类医疗中心表现更好。对于西班牙裔/拉丁裔患者，就所有3项结果而言，成立时间较长的医疗中心比新建医疗中心表现更好。与没有管理式医疗渗透的医疗中心相比，有一定管理式医疗渗透的医疗中心在糖尿病和高血压控制方面做得更好。与全国 rates相比，医疗中心报告的临床结果中的种族/族裔差异最小。医疗中心特征也与临床结果相关。在考虑医疗中心患者、提供者和机构特征后，需要更多研究来确定差异的性质。
