Department of Health Law, Policy, & Management, Boston University School of Public Health, Boston, MA, USA.
Department of Health Services, Policy, & Practice, Brown University School of Public Health, Boston, MA, USA.
J Gen Intern Med. 2018 Jun;33(6):906-913. doi: 10.1007/s11606-018-4305-1. Epub 2018 Feb 16.
To monitor progress towards eliminating health disparities, community health centers have reported on hypertension control, diabetes control, and birthweight by race and ethnicity since 2008.
To evaluate racial/ethnic time trends in quality outcomes in health centers and to assess both within- and between-center disparities in outcomes.
Using 2009-2014 data from all US health centers (n = 1047 centers, serving 19.6 million patients/year), we evaluated racial/ethnic time trends in quality outcomes for health centers and assessed within- and between-center disparities.
Percentage of patients achieving control of blood pressure < 140/90 mmHg among hypertensive persons, control of glycosylated hemoglobin ≤ 9.0% among diabetic persons, and birthweight ≥ 2500 g. All outcomes were reported by race/ethnicity.
There was no evidence of improved outcomes among racial/ethnic subgroups from 2009 to 2014, though electronic health record adoption, medical recognition, and insurance coverage rates increased substantially. Two exceptions were increased rates of normal birthweight for black patients (87.0% to 88.8%, or 0.3 percentage points/year, p = 0.02) and decreased rates of diabetes control for white patients (74.2% to 69.5%, or -1.0 percentage points/year, p < 0.01). Within centers, the largest racial/ethnic disparities in 2009 were white/black disparities in hypertension control (8.7 percentage points, 95% CI 7.4-10.1), white/black disparities in diabetes control (3.4 percentage points, 95% CI 2.0-4.7), and white/Hispanic disparities in diabetes control (4.4 percentage points, 95% CI 2.8-6.0). All disparities remained statistically unchanged from 2009 to 2014. White patients were more likely to be seen at a health center in the top performance quintile compared with black and Hispanic patients (p < 0.001).
Though quality outcomes in health centers continued to compare favorably to other care settings, we found no evidence of improved quality or reduced disparities in diabetes control, hypertension control, or birthweight from 2009 to 2014. Within- and between-center racial/ethnic disparities in quality were evident, and both should be targeted in future interventions.
自 2008 年以来，社区卫生中心一直在报告按种族和族裔划分的高血压控制、糖尿病控制和出生体重情况，以监测消除健康差异的进展。
评估卫生中心的种族/民族质量结果的时间趋势，并评估结果的中心内和中心间差异。
使用来自全美所有卫生中心（n=1047 个中心，每年服务 1960 万患者）的 2009-2014 年数据，我们评估了卫生中心质量结果的种族/民族时间趋势，并评估了中心内和中心间的差异。
高血压患者血压<140/90mmHg 的控制率、糖尿病患者糖化血红蛋白≤9.0%的控制率和出生体重≥2500g 的比例。所有结果均按种族/族裔报告。
从 2009 年到 2014 年，各种族/族裔亚组的结果没有改善的迹象，尽管电子健康记录的采用、医疗认可和保险覆盖率大幅提高。有两个例外是黑人群体的正常出生体重比例增加（从 87.0%增加到 88.8%，或每年增加 0.3 个百分点，p=0.02）和白人群体的糖尿病控制率下降（从 74.2%下降到 69.5%，或每年下降 1.0 个百分点，p<0.01）。在中心内，2009 年最大的种族/族裔差异是高血压控制方面的白种人/黑种人差异（8.7 个百分点，95%CI 7.4-10.1）、糖尿病控制方面的白种人/黑种人差异（3.4 个百分点，95%CI 2.0-4.7）和糖尿病控制方面的白种人/西班牙裔差异（4.4 个百分点，95%CI 2.8-6.0）。所有差异从 2009 年到 2014 年都没有统计学上的变化。与黑人和西班牙裔患者相比，白种人更有可能在表现最好的五分位组的卫生中心就诊（p<0.001）。
尽管卫生中心的质量结果继续优于其他护理环境，但我们没有发现从 2009 年到 2014 年糖尿病控制、高血压控制或出生体重方面的质量改善或差异缩小的证据。中心内和中心间的种族/民族质量差异明显，这两者都应该成为未来干预措施的目标。
