Stanford University School of Medicine, Stanford, California, USA.
The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Health Serv Res. 2021 Jun;56(3):507-516. doi: 10.1111/1475-6773.13637. Epub 2021 Feb 11.
This study sought to identify potential disparities among racial/ethnic groups in patient perceptions of integrated care (PPIC) and to explore how methodological differences may influence measured disparities.
Data from Medicare beneficiaries who completed the 2015 Medicare Current Beneficiary Survey (MCBS) and were enrolled in Part A benefits for an entire year.
We used 4-point measures of eight dimensions of PPIC and assessed differences in dimensions among racial/ethnic groups. To estimate differences, we applied a "rank and replace" method using multiple regression models in three steps, balancing differences in health status among racial groups and adjusting for differences in socioeconomic status. We reran all analyses with additional SES controls and using standard multiple variable regression.
DATA COLLECTION/EXTRACTION METHODS: Not applicable.
We found several significant differences in perceived integrated care between Black versus White (three of eight measures) and Hispanic versus White (one of eight) Medicare beneficiaries. On average, Black beneficiaries perceived more integrated support for self-care than did White beneficiaries (mean difference = 0.14, SE = 0.06, P =.02). Black beneficiaries perceived more integrated specialists' knowledge of past medical history than did White beneficiaries (mean difference = 0.12, SE = 0.06, P =.01). Black and Hispanic beneficiaries also each reported, on average, 0.18 more integrated medication and home health management than did White beneficiaries (P <.01 and P <.01). These findings were robust to sensitivity analyses and model specifications.
There exist some aspects of care for which Black and Hispanic beneficiaries may perceive greater integrated care than non-Hispanic White beneficiaries. Further studies should test theories explaining why racial/ethnic groups perceive differences in integrated care.
本研究旨在确定患者对综合护理的感知（PPIC）在不同种族/民族群体中的潜在差异，并探讨方法学差异如何影响测量的差异。
数据来自于完成了 2015 年 Medicare 现行受益人调查（MCBS）且全年都参加了 Medicare 部分 A 福利的 Medicare 受益人。
我们使用了八项 PPIC 维度的 4 分制衡量标准，并评估了不同种族/民族群体在这些维度上的差异。为了估计差异，我们使用了一种“排名和替换”方法，在三个步骤中使用多元回归模型，平衡了种族群体之间的健康状况差异，并调整了社会经济地位的差异。我们在所有分析中都重新运行了，并增加了 SES 控制项，同时使用了标准多变量回归。
数据收集/提取方法：不适用。
我们发现，黑人和白人（八项中的三项）以及西班牙裔和白人（八项中的一项）的 Medicare 受益人在感知的综合护理方面存在一些显著差异。平均而言，黑人受益人比白人受益人更能感受到自我护理方面的综合支持（平均差异=0.14，SE=0.06，P=.02）。黑人受益人比白人受益人更能感受到专家对既往病史的综合了解（平均差异=0.12，SE=0.06，P=.01）。黑人受益人和西班牙裔受益人还报告称，平均而言，他们比白人受益人在综合药物和家庭健康管理方面多 0.18（P<.01 和 P<.01）。这些发现对敏感性分析和模型规格具有稳健性。
在某些方面，黑人受益人和西班牙裔受益人的综合护理感知可能比非西班牙裔白人受益人的综合护理感知要好。进一步的研究应该检验解释为什么不同种族/民族群体在综合护理感知方面存在差异的理论。
