Department of Orthopedic Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Ann Surg. 2019 Mar;269(3):459-464. doi: 10.1097/SLA.0000000000002695.
To assess the effect of Accountable Care Organizations (ACOs) on the use of surgical services among racial and ethnic minorities.
Health reform efforts were expected to reduce healthcare disparities. The impact of ACOs on existing disparities in access to surgical care remains unknown.
We used national Medicare data (2009-2014) to compare rates of surgery among white, African American, Hispanic, and Asian Medicare beneficiaries for coronary artery bypass grafting, colectomy, total hip arthroplasty, hip fracture repair, and lumbar spine surgery. We performed a pre-post difference in differences analysis between African American, Hispanic, and Asian patients receiving surgical care in ACO and non-ACO organizations before and after the implementation of ACOs. The time period 2009 to 2011 was considered the pre-ACO period, and 2012 to 2014 the post-ACO period.
Rates of surgical intervention in the ACO cohort were significantly lower (P < 0.001) as compared to non-ACOs for whites, African Americans, Hispanics, and Asians in both the pre- and post-ACO periods. There was no significant difference in the adjusted change in the rate of surgical interventions among minority patients as compared to whites in ACOs and non-ACOs between 2009 to 2011 and 2012 to 2014. The odds of receiving surgical intervention were lowest for minority patients in ACOs during the post-ACO period (P < 0.001).
We found persistent differences in the use of surgery among racial and ethnic minorities between the time periods 2009 to 2011 and 2012 to 2014. These disparities were not impacted by the formation of ACOs. Programs that specifically incentivize ACOs to improve surgical access for minorities may be necessary.
评估问责制医疗组织（ACO）对少数民族使用手术服务的影响。
医疗改革预计将减少医疗保健差异。ACO 对现有手术护理获取差距的影响尚不清楚。
我们使用国家医疗保险数据（2009-2014 年），比较了在接受冠状动脉旁路移植术、结肠切除术、全髋关节置换术、髋部骨折修复术和腰椎手术治疗的白种人、非裔美国人、西班牙裔和亚洲裔 Medicare 受益人的手术率。我们在 ACO 和非 ACO 组织中接受手术护理的非裔美国人、西班牙裔和亚洲患者在 ACO 实施前后进行了差异中的差异分析。2009 年至 2011 年期间被认为是 ACO 之前的时期，2012 年至 2014 年期间是 ACO 之后的时期。
在 ACO 队列中，与非 ACO 相比，白人、非裔美国人、西班牙裔和亚洲人在 ACO 前后的手术干预率均显著降低（P <0.001）。在 ACO 和非 ACO 中，与白人相比，少数民族患者的手术干预率在 2009 年至 2011 年和 2012 年至 2014 年之间没有显著差异。在 ACO 后时期，少数民族患者接受手术干预的可能性最低（P <0.001）。
我们发现，在 2009 年至 2011 年和 2012 年至 2014 年期间，少数民族在手术使用方面存在持续的差异。这些差异不受 ACO 形成的影响。可能需要制定专门激励 ACO 改善少数民族手术机会的计划。
