Department of Health Policy and Management, School of Public Health, University of Maryland, College Park.
The Hospital And Public Health Interdisciplinary Research Lab, School of Public Health, University of Maryland, College Park.
JAMA Netw Open. 2022 Sep 1;5(9):e2233436. doi: 10.1001/jamanetworkopen.2022.33436.
Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures have been used widely to measure patient-centered care. Evidence is needed to understand CAHPS measures among racial and ethnic minority patients with Alzheimer disease and related dementias (ADRD).
To examine racial and ethnic disparities in CAHPS among patients with ADRD and to examine the association between social determinants of health and CAHPS disparities.
DESIGN, SETTING, AND PARTICIPANTS: This study focused on patients with ADRD who were enrolled in Medicare Shared Savings Program Accountable Care Organizations (ACOs). The primary data sets were the 2017 Medicare Beneficiary Summary File and the beneficiary-level ACO data. The study population was limited to community-based beneficiaries who had a diagnosis of ADRD and were aged 65 years and older. Cross-sectional analyses and the decomposition approach were implemented. Data were analyzed from November 2021 to July 2022.
Enrollment in a Medicare Shared Savings Program ACO.
Six ACO CAHPS measures were included: getting timely care, appointments, and information; how well providers communicate; patients' rating of provider; access to specialists; health promotion and education; and shared decision-making. ACO CAHPS were continuous measures with possible ranges from 0 to 100. The summation of these 6 measures as an overall index was also created. In CAHPS measures, the term provider can include hospitals, home health care agencies, and doctors, among others.
The final sample included 568 368 beneficiaries (347 783 female patients [61.2%]; 38 030 African American patients [6.69%], 6258 Asian patients [1.10%], 18 231 Hispanic patients [3.21%], and 505 849 White patients [89.0%]; mean [SD] age, 82.17 [7.95] years). Significant racial and ethnic disparities in CAHPS scores were observed. After controlling for beneficiary, hospital, and area characteristics, compared with their White counterparts, African American or Black (coefficient = -1.05; 95% CI, -1.15 to -0.95; P < .001), Asian (coefficient = -0.414; 95% CI, -0.623 to -0.205; P < .001), and Hispanic (coefficient = -0.099; 95% CI, -0.229 to 0.032; P = .14) patients with ADRD reported lower total CAHPS scores. Disparities were also observed among individual ACO CAHPS. Decomposition results showed that a proxy for social determinants of health explained 10% to 13% of disparities of ACO CAHPS between African American or Black vs White and Hispanic vs White patients with ADRD. Most of the racial and ethnic disparities, especially those between White and Asian individuals, could not be explained by the models used to analyze data.
These results demonstrated significant variations in CAHPS by race and ethnicity among patients with ADRD enrolled in ACOs. Social determinants of health are critical in explaining racial and ethnic disparities. More research is needed to explain disparities in CAHPS.
消费者对医疗保健提供者和系统（CAHPS）的评估已被广泛用于衡量以患者为中心的护理。需要有证据来了解阿尔茨海默病和相关痴呆症（ADRD）的少数族裔和族裔患者的 CAHPS 衡量标准。
检查 ADRD 患者中 CAHPS 的种族和族裔差异，并研究健康社会决定因素与 CAHPS 差异之间的关联。
设计、设置和参与者：本研究重点是参加医疗保险储蓄计划管理式医疗组织（ACO）的 ADRD 患者。主要数据集是 2017 年医疗保险受益人大纲文件和受益人大纲 ACO 数据。研究人群仅限于社区受益人的诊断为 ADRD，年龄在 65 岁及以上。实施了横断面分析和分解方法。数据分析于 2021 年 11 月至 2022 年 7 月进行。
参加医疗保险储蓄计划 ACO。
纳入了 6 项 ACO CAHPS 衡量标准：及时获得护理、预约和信息；提供者的沟通程度；患者对提供者的评价；获得专家的途径；健康促进和教育；以及共同决策。ACO CAHPS 是连续衡量标准，可能范围为 0 到 100。还创建了这些 6 个措施的总和作为整体指数。在 CAHPS 措施中，术语“提供者”可以包括医院、家庭保健机构和医生等。
最终样本包括 568368 名受益人的数据（347783 名女性患者[61.2%]；38030 名非裔美国患者[6.69%]，6258 名亚洲患者[1.10%]，18231 名西班牙裔患者[3.21%]和 505849 名白人患者[89.0%]；平均[标准差]年龄为 82.17[7.95]岁）。观察到 CAHPS 评分存在显著的种族和族裔差异。在控制受益人和医院特征后，与白人患者相比，非裔美国或黑种人（系数=−1.05；95%置信区间，−1.15 至−0.95；P<0.001）、亚洲人（系数=−0.414；95%置信区间，−0.623 至−0.205；P<0.001）和西班牙裔（系数=−0.099；95%置信区间，−0.229 至 0.032；P=0.14）的 ADRD 患者报告的总 CAHPS 评分较低。在个别 ACO CAHPS 中也观察到差异。分解结果表明，社会决定因素的代表可以解释 10%至 13%的非裔美国或黑种人与白种人以及西班牙裔与白种人之间的 ACO CAHPS 差异。大多数种族和族裔差异，尤其是白人和亚洲人之间的差异，无法用用于分析数据的模型来解释。
这些结果表明，在参加 ACO 的 ADRD 患者中，CAHPS 存在显著的种族和族裔差异。健康的社会决定因素对于解释种族和族裔差异至关重要。需要进一步研究来解释 CAHPS 的差异。
