RAND Corporation, Pittsburgh, PA.
RAND Corporation, Santa Monica, CA.
Med Care. 2018 Sep;56(9):749-754. doi: 10.1097/MLR.0000000000000936.
Disparities in clinical process-of-care and patient experiences are well documented for Medicare beneficiaries with ≥1 social risk factors. If such patients are less willing to express disagreement with their doctors or change doctors when dissatisfied, these behaviors may play a role in observed disparities.
To investigate the association between social risk factors and self-reported likelihood of disagreeing with or changing doctors if dissatisfied among the Medicare fee-for-service population.
Fee-for-service beneficiaries (N=96,317) who responded to the 2014 Medicare Consumer Assessment of Healthcare Providers and Systems survey. Subgroups were defined based on age, education, income, and race/ethnicity.
Respondents reported how likely they would be to express disagreement with their doctors and change doctors if dissatisfied (1=very unlikely to 4=very likely; rescaled to 0-100 points). We fit mixed-effect linear regression models predicting these outcomes from social risk factors, controlling for health status and geographic location.
Beneficiaries who were older, less educated, and had lower incomes were least inclined to express disagreement or change doctors (P<0.001). Compared with non-Hispanic whites, Asian/Pacific Islander (-9.5) and Hispanic (-3.6) beneficiaries said they would be less likely, and black (+2.8) beneficiaries more likely, to express disagreement. Asian/Pacific Islander (-8.7), Hispanic (-5.9), and American Indian/Alaska Native (-3.8) beneficiaries were less inclined than non-Hispanic whites to change doctors (P<0.01).
Reduction in health care disparities may be achieved if doctors and advocates encourage vulnerable patients to express their concerns and perspectives and if communities and caregivers provide support for changing providers when care is poor.
对于至少有 1 个社会风险因素的 Medicare 受益人，临床医疗过程和患者体验方面的差异有充分的记录。如果这些患者不太愿意表达对医生的不同意见，或者在不满意时更换医生，那么这些行为可能在观察到的差异中发挥作用。
调查 Medicare 按服务收费人群中，社会风险因素与报告的如果不满意则更不愿意表达不同意见或更换医生的可能性之间的关联。
对 2014 年 Medicare 医疗保健提供者和系统消费者评估调查做出回应的按服务收费受益人的样本（N=96317）。根据年龄、教育程度、收入和种族/族裔定义亚组。
受访者报告了他们在不满意时表示不同意医生意见和更换医生的可能性（1=极不可能，4=极有可能；重新调整为 0-100 分）。我们使用混合效应线性回归模型，根据社会风险因素预测这些结果，同时控制健康状况和地理位置。
年龄较大、教育程度较低和收入较低的受益人表示不同意或更换医生的可能性最小（P<0.001）。与非西班牙裔白人相比，亚裔/太平洋岛民（-9.5）和西班牙裔（-3.6）受益人的表示他们更不可能表示不同意，而黑人（+2.8）受益人的表示他们更可能表示不同意。与非西班牙裔白人相比，亚裔/太平洋岛民（-8.7）、西班牙裔（-5.9）和美国印第安人/阿拉斯加原住民（-3.8）的受益人的更不愿意更换医生（P<0.01）。
如果医生和倡导者鼓励弱势患者表达他们的关切和观点，如果社区和护理人员在护理质量差时为更换提供者提供支持，那么可能会减少医疗保健差异。
