Harvard/Massachusetts General Hospital Medicine-Pediatrics Residency Program, Boston, MA, USA.
Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
J Gen Intern Med. 2018 Apr;33(4):463-470. doi: 10.1007/s11606-017-4227-3. Epub 2018 Jan 8.
Healthcare systems use population health management programs to improve the quality of cardiovascular disease care. Adding a dedicated population health coordinator (PHC) who identifies and reaches out to patients not meeting cardiovascular care goals to these programs may help reduce disparities in cardiovascular care.
To determine whether a program that used PHCs decreased racial/ethnic disparities in LDL cholesterol and blood pressure (BP) control.
Retrospective difference-in-difference analysis.
Twelve thousdand five hundred fifty-five primary care patients with cardiovascular disease (cohort for LDL analysis) and 41,183 with hypertension (cohort for BP analysis).
From July 1, 2014-December 31, 2014, 18 practices used an information technology (IT) system to identify patients not meeting LDL and BP goals; 8 practices also received a PHC. We examined whether having the PHC plus IT system, compared with having the IT system alone, decreased racial/ethnic disparities, using difference-in-difference analysis of data collected before and after program implementation.
Meeting guideline concordant LDL and BP goals.
At baseline, there were racial/ethnic disparities in meeting LDL (p = 0.007) and BP (p = 0.0003) goals. Comparing practices with and without a PHC, and accounting for pre-intervention LDL control, non-Hispanic white patients in PHC practices had improved odds of LDL control (OR 1.20 95% CI 1.09-1.32) compared with those in non-PHC practices. Non-Hispanic black (OR 1.15 95% CI 0.80-1.65) and Hispanic (OR 1.29 95% CI 0.66-2.53) patients saw similar, but non-significant, improvements in LDL control. For BP control, non-Hispanic white patients in PHC practices (versus non-PHC) improved (OR 1.13 95% CI 1.05-1.22). Non-Hispanic black patients (OR 1.17 95% CI 0.94-1.45) saw similar, but non-statistically significant, improvements in BP control, but Hispanic (OR 0.90 95% CI 0.59-1.36) patients did not. Interaction testing confirmed that disparities did not decrease (p = 0.73 for LDL and p = 0.69 for BP).
The population health management intervention did not decrease disparities. Further efforts should explicitly target improving both healthcare equity and quality. Clinical Trials #: NCT02812303 ( ClinicalTrials.gov ).
医疗保健系统采用人群健康管理计划来提高心血管疾病护理质量。在这些计划中增加专门的人群健康协调员（PHC），以识别和联系不符合心血管护理目标的患者，可能有助于减少心血管护理方面的差异。
确定使用 PHC 的计划是否降低了 LDL 胆固醇和血压（BP）控制方面的种族/民族差异。
回顾性差异差异分析。
12555 名患有心血管疾病的初级保健患者（LDL 分析队列）和 41183 名患有高血压的患者（BP 分析队列）。
从 2014 年 7 月 1 日至 2014 年 12 月 31 日，18 个实践使用信息技术（IT）系统来识别不符合 LDL 和 BP 目标的患者；8 个实践还配备了 PHC。我们通过比较实施计划前后收集的数据的差异差异分析，检查是否存在 PHC 加 IT 系统，与仅存在 IT 系统相比，是否减少了种族/民族差异。
符合指南的 LDL 和 BP 目标。
在基线时，在符合 LDL（p=0.007）和 BP（p=0.0003）目标方面存在种族/民族差异。比较有和没有 PHC 的实践，并考虑到干预前的 LDL 控制情况，与非 PHC 实践相比，PHC 实践中的非西班牙裔白人患者的 LDL 控制改善的可能性更高（OR 1.20，95%CI 1.09-1.32）。非西班牙裔黑人（OR 1.15，95%CI 0.80-1.65）和西班牙裔（OR 1.29，95%CI 0.66-2.53）患者的 LDL 控制也有类似但无统计学意义的改善。对于 BP 控制，PHC 实践中的非西班牙裔白人患者（与非 PHC 实践相比）有所改善（OR 1.13，95%CI 1.05-1.22）。非西班牙裔黑人患者（OR 1.17，95%CI 0.94-1.45）的 BP 控制也有类似但无统计学意义的改善，但西班牙裔患者（OR 0.90，95%CI 0.59-1.36）则没有。交互测试证实差异没有减小（p=0.73 用于 LDL，p=0.69 用于 BP）。
人群健康管理干预并未减少差异。应进一步努力明确提高医疗保健公平性和质量。临床试验 #: NCT02812303（ClinicalTrials.gov）。
