HealthLandscape, American Academy of Family Physicians, Leawood, Kansas, USA
HealthLandscape, American Academy of Family Physicians, Leawood, Kansas, USA.
Fam Med Community Health. 2021 Jul;9(3). doi: 10.1136/fmch-2020-000853.
This paper explores the impact of service area-level social deprivation on health centre clinical quality measures.
Cross-sectional data analysis of Health Resources and Services Administration (HRSA)-funded health centres. We created a weighted service area social deprivation score for HRSA-funded health centres as a proxy measure for social determinants of health, and then explored adjusted and unadjusted clinical quality measures by weighted service area Social Deprivation Index quartiles for health centres.
HRSA-funded health centres in the USA.
Our analysis included a subset of 1161 HRSA-funded health centres serving more than 22 million mostly low-income patients across the country.
Higher levels of social deprivation are associated with statistically significant poorer outcomes for all clinical quality outcome measures (both unadjusted and adjusted), including rates of blood pressure control, uncontrolled diabetes and low birth weight. The adjusted and unadjusted results are mixed for clinical quality process measures as higher levels of social deprivation are associated with better quality for some measures including cervical cancer screening and child immunisation status but worse quality for other such as colorectal cancer screening and early entry into prenatal care.
This research highlights the importance of incorporating community characteristics when evaluating clinical outcomes. We also present an innovative method for capturing health centre service area-level social deprivation and exploring its relationship to health centre clinical quality measures.
本文探讨了服务区社会剥夺程度对医疗中心临床质量指标的影响。
对美国卫生资源和服务管理局（HRSA）资助的医疗中心进行横断面数据分析。我们创建了一个加权服务区社会剥夺评分，作为医疗中心健康决定因素的替代指标，然后根据加权服务区社会剥夺指数四分位数，探讨了调整和未调整的医疗中心临床质量指标。
美国 HRSA 资助的医疗中心。
我们的分析包括在美国全国范围内为超过 2200 万主要是低收入患者服务的 1161 个 HRSA 资助医疗中心的一个子集。
社会剥夺程度越高，所有临床质量结果指标（包括未经调整和调整后的血压控制率、未控制的糖尿病和低出生体重率）的结果越差。临床质量过程指标的调整和未调整结果存在差异，因为较高的社会剥夺程度与某些指标的较高质量相关，包括宫颈癌筛查和儿童免疫状况，但与其他指标的质量较差相关，如结直肠癌筛查和早期进入产前护理。
这项研究强调了在评估临床结果时纳入社区特征的重要性。我们还提出了一种创新的方法来捕捉医疗中心服务区的社会剥夺程度，并探讨其与医疗中心临床质量指标的关系。
