Darnell Julie S, Perry Michael, Lamoureux Nicole, Lee Edith
Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, Illinois, USA.
Department of Mathematics and Statistics, College of Arts and Sciences, Loyola University Chicago, Chicago, IL, USA.
Health Equity. 2022 Sep 15;6(1):708-716. doi: 10.1089/heq.2022.0078. eCollection 2022.
Free and charitable clinics (FCCs), nonprofits that utilize volunteer licensed health care professionals to provide health services at no cost or a small fee to low-income uninsured patients who are disproportionately from underrepresented communities, have been part of the safety net for over a century. Approximately 1400 known FCCs serve two million patients annually. Despite their longevity and sizable number, evidence regarding the quality of care in FCCs is lacking. We report new evidence generated by a national initiative, the Roadmap to Health Equity. Established in 2017, this consortium is co-led by two national organizations serving FCCs and an academic institution. It has involved more than 150 FCC stakeholders with the shared goal of improving the quality of care and reducing inequities. The centerpiece is a custom national data repository of 15 validated clinical quality measures and patient-level characteristics.
Fifty FCCs pilot tested the data repository. Clinics submitted patient-level data on two blood pressure (BP) measures and at least one additional measure. Descriptive statistics were stratified by sex, race, ethnicity, and language.
In 2021, 33 pilot FCCs from 21 states reported data across 13 of the 15 clinical measures, representing 34,359 unique patients. For example, on average, 60% of patients had controlled BP, but Black patients had lower rates of BP control than Hispanic and White patients (55.9% vs. 62.1% and 63.0%, respectively).
Our findings demonstrate a proof of concept. By standardizing quality measures alongside patient characteristics, clinics can become aware of racial/ethnic inequalities in health outcomes. This information can motivate clinics to investigate the causes and implement solutions. In an environment where outcome data from FCCs are scarce, the new national data repository lays the foundation for routine stratified reporting of a range of quality outcomes for an important safety net for the uninsured.
免费慈善诊所（FCCs）是利用持牌志愿医护人员为低收入未参保患者免费或收取少量费用提供医疗服务的非营利组织，这些患者大多来自代表性不足的社区，一个多世纪以来一直是安全网的一部分。约1400家已知的免费慈善诊所每年为200万患者提供服务。尽管它们存在时间长且数量可观，但缺乏关于免费慈善诊所医疗质量的证据。我们报告了一项全国性倡议“健康公平路线图”产生的新证据。该联盟于2017年成立，由两个服务于免费慈善诊所的全国性组织和一个学术机构共同牵头。它有150多个免费慈善诊所利益相关者参与，共同目标是提高医疗质量并减少不平等。核心是一个定制的全国性数据库，包含15项经过验证的临床质量指标和患者层面特征。
50家免费慈善诊所对该数据库进行了试点测试。诊所提交了关于两项血压（BP）测量指标以及至少一项其他指标的患者层面数据。描述性统计按性别、种族、民族和语言进行分层。
2021年，来自21个州的33家试点免费慈善诊所报告了15项临床指标中13项的数据，代表34359名不同患者。例如，平均而言，60%的患者血压得到控制，但黑人患者的血压控制率低于西班牙裔和白人患者（分别为55.9%、62.1%和63.0%）。
我们的研究结果证明了概念验证。通过将质量指标与患者特征标准化，诊所能够意识到健康结果中的种族/民族不平等。这些信息可促使诊所调查原因并实施解决方案。在免费慈善诊所结果数据稀缺的环境中，新的全国性数据库为常规分层报告一系列质量结果奠定了基础，这些结果对于未参保者的重要安全网而言至关重要。
