Wagner School of Public Service, New York University, New York, NY.
Med Care. 2023 Apr 1;61(4):216-221. doi: 10.1097/MLR.0000000000001827. Epub 2023 Feb 3.
To assess the extent of segregation between racial and ethnic minority and White patients across primary care physicians and the association of practice panel racial/ethnic composition with the quality of care delivered.
We examined the degree of racial/ethnic dissimilarity (a measure of segregation) in visits and the allocation of patient visits by different groups across primary care physicians (PCPs). We assessed the regression-adjusted relationship between the racial/ethnic composition of PCP practices and measures of the quality of care delivered. We compared outcomes in the pre-Affordable Care Act (ACA) and post-ACA (2006-2010/2011-2016) periods.
We analyzed data on all primary care visits to office-based practitioners in the 2006-2016 National Ambulatory Medical Care Survey. PCPs were defined as general/family practice or internal medicine physicians. We excluded cases with imputed race or ethnicity information. For the quality of care analyses, we limited the sample to adults.
Racial and ethnic minority patients remain concentrated within a small group of PCPs: 35% of PCPs accounted for 80% of non-White patients' visits; 63% of non-White (or White) patients would need to switch physicians to make the distribution of visits across PCPs proportional between the groups. We observed little correlation between the PCPs panel's racial/ethnic composition and quality of care. These patterns did not change substantially over time.
PCPs remain segregated, but the racial/ethnic composition of a practice panel is not associated with the quality of health care that individual patients receive in either the pre or post-ACA passage periods.
评估初级保健医生之间的族裔和少数民族患者与白人患者之间的隔离程度，以及实践小组的种族/民族构成与所提供的护理质量之间的关联。
我们检查了不同初级保健医生（PCP）之间就诊和患者就诊分配的种族/民族差异程度（衡量隔离程度的指标）。我们评估了 PCP 实践的种族/民族构成与所提供的护理质量衡量指标之间的回归调整关系。我们比较了平价医疗法案（ACA）之前和之后（2006-2010/2011-2016）时期的结果。
我们分析了 2006-2016 年全国门诊医疗调查中所有初级保健门诊就诊的数据。PCP 被定义为全科/家庭医生或内科医生。我们排除了种族或族裔信息有估算值的病例。对于护理质量分析，我们将样本限制在成年人。
族裔和少数民族患者仍然集中在少数 PCP 中：35%的 PCP 占非白人患者就诊量的 80%；63%的非白人（或白人）患者需要更换医生，以使 PCP 之间的就诊分布在两组之间成比例。我们观察到 PCP 小组的种族/民族构成与护理质量之间几乎没有相关性。这些模式在时间上没有发生重大变化。
PCP 仍然存在隔离现象，但实践小组的种族/民族构成与个体患者在 ACA 前后任何时期接受的医疗保健质量都没有关联。
