Cole Megan B, Wilson Ira B, Trivedi Amal N
*Department of Health Law, Policy, & Management, Boston University School of Public Health, Boston, MA†Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI.
Med Care. 2017 Dec;55(12):1001-1007. doi: 10.1097/MLR.0000000000000818.
Prior studies have reported that community health centers perform as well as other sites of care, despite serving more vulnerable patient populations. However, there is little prior study of geographic variation in quality outcomes and disparities in outcomes in this setting. Quantifying geographic variation is important so as to target quality improvement efforts and funding and to learn from states where total quality is highest and racial/ethnic disparities are lowest.
To estimate between-state variation in hypertension, diabetes, and pregnancy outcomes and racial/ethnic disparities in these outcomes for health center patients.
Using data on all US health centers from 2010 to 2014 (N=1047 health centers/year, or 21.2 million patients in 2014), we used linear regression models to estimate adjusted quality outcomes and racial/ethnic disparities in quality outcomes by state for hypertension control, diabetes control, and normal birthweight.
We found wide variation in both outcomes and racial/ethnic disparities in outcomes between states for patients seen at health centers. For instance, between states, the mean proportion of patients with hypertension control ranged from 58% to 70% for white patients, from 49% to 64% for black patients, and from 53% to 74% for Hispanic patients (P<0.001). Racial/ethnic disparities in outcomes ranged from negative or nonsignificant in some states to positive in others.
Wide variation in health center patient outcomes and disparities in outcomes is observed between states. This variation suggests that policymakers should target funding and interventions to underperforming states, and identify determinants of high quality in higher performing states.
先前的研究报告称，尽管社区卫生中心服务的患者群体更为脆弱，但它们的表现与其他医疗场所相当。然而，此前很少有关于该环境下质量结果的地理差异以及结果差异的研究。量化地理差异很重要，以便针对质量改进工作和资金投入，并向总体质量最高且种族/族裔差异最小的州学习。
估计社区卫生中心患者在高血压、糖尿病和妊娠结局方面的州际差异以及这些结局中的种族/族裔差异。
利用2010年至2014年美国所有社区卫生中心的数据（每年1047个社区卫生中心，2014年有2120万患者），我们使用线性回归模型来估计各州在高血压控制、糖尿病控制和正常出生体重方面的调整后质量结果以及质量结果中的种族/族裔差异。
我们发现，社区卫生中心患者的结局以及结局中的种族/族裔差异在各州之间存在很大差异。例如，在各州之间，白人患者高血压得到控制的平均比例在58%至70%之间，黑人患者在49%至64%之间，西班牙裔患者在53%至74%之间（P<0.001）。结局中的种族/族裔差异在一些州为负或不显著，而在另一些州为正。
各州之间社区卫生中心患者的结局以及结局差异存在很大差异。这种差异表明，政策制定者应将资金和干预措施针对表现不佳的州，并确定表现较好州高质量的决定因素。
