Wright Brad, Akiyama Jill, Potter Andrew J, Sabik Lindsay M, Stehlin Grace G, Trivedi Amal N, Wolinsky Fredric D
Department of Family Medicine, UNC-Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.
Cecil G. Sheps Center for Health Services Research, UNC-Chapel Hill, Chapel Hill, North Carolina, USA.
Health Equity. 2023 Jan 13;7(1):9-18. doi: 10.1089/heq.2022.0037. eCollection 2023.
Health center use may reduce hospital-based care among Medicare-Medicaid dual eligibles, but racial and ethnic disparities in this population have not been widely studied. We examined the extent of racial and ethnic disparities in hospital-based care among duals using health centers and the degree to which disparities occur within or between health centers.
We used 2012-2018 Medicare claims and health center data to model emergency department (ED) visits, observation stays, hospitalizations, and 30-day unplanned returns as a function of race and ethnicity among dual eligibles using health centers.
In rural and urban counties, age-eligible Black individuals had more ED visits (7.9 [4.0, 11.7] and 13.7 [10.0, 17.4] per 100 person-years) and were more likely to experience an unplanned return (1.4 [0.4, 2.4] and 1 [0.4, 1.6] percentage points [pp]) than White individuals, but were less likely to be hospitalized (-3.3 [-3.9, -2.8] and -1.2 [-1.6, -0.9] pp). In urban counties, age-eligible Black individuals were 1.2 [0.9, 1.5] pp more likely than White individuals to have observation stays. Other racial and ethnic groups used the same or less hospital-based care than White individuals. Including state and health center fixed effects eliminated Black versus White disparities in all outcomes, except hospitalization. Results were similar among disability-eligible duals.
Racial and ethnic disparities in hospital-based care among dual eligibles are less common within than between health centers. If health centers are to play a more central role in eliminating racial and ethnic health disparities, these differences across health centers must be understood and addressed.
使用健康中心可能会减少医疗保险 - 医疗补助双重资格者的住院治疗，但该人群中的种族和民族差异尚未得到广泛研究。我们研究了使用健康中心的双重资格者在住院治疗方面的种族和民族差异程度，以及差异在健康中心内部或之间出现的程度。
我们使用2012 - 2018年医疗保险索赔和健康中心数据，将急诊科就诊、观察住院、住院治疗以及30天内非计划再入院建模为使用健康中心的双重资格者种族和民族的函数。
在农村和城市县，符合年龄条件的黑人个体每100人年的急诊科就诊次数更多（分别为7.9[4.0, 11.7]次和13.7[10.0, 17.4]次），且比白人个体更有可能经历非计划再入院（分别为1.4[0.4, 2.4]个百分点和1[0.4, 1.6]个百分点），但住院的可能性较小（分别为 - 3.3[-3.9, -2.8]个百分点和 - 1.2[-1.6, -0.9]个百分点）。在城市县，符合年龄条件的黑人个体比白人个体进行观察住院的可能性高1.2[0.9, 1.5]个百分点。其他种族和民族群体使用的住院治疗与白人个体相同或更少。纳入州和健康中心固定效应后，除住院治疗外，所有结果中黑人与白人之间的差异均消除。在符合残疾条件的双重资格者中结果相似。
双重资格者在住院治疗方面的种族和民族差异在健康中心内部比在健康中心之间少见。如果健康中心要在消除种族和民族健康差异方面发挥更核心的作用，就必须理解并解决这些健康中心之间的差异。
