Rodriguez Hector P, Xu Shihan, Brewster Amanda L, Brown Timothy T, Chen Stacy, Epstein Sarah D
Division of Health Policy and Management, School of Public Health, University of California, Berkeley, 94704, United States of America.
Health Aff Sch. 2024 Nov 21;2(12):qxae155. doi: 10.1093/haschl/qxae155. eCollection 2024 Dec.
There is limited information about accountable care organization (ACO) variation in equity of ambulatory care quality. We examine whether equity of care changed for racial and ethnic minority patients from 2019 to 2022 and the extent to which equity of care performance varied for 11 ACOs in Massachusetts over time. We analyzed ACO-level changes in equity of care for 8 ambulatory care quality measures for Asian, Black, and Hispanic patients, measured as the percentage point difference between each group and the majority non-Hispanic White patient group. Cervical cancer screening (3.54 percentage point change, < 0.001), colorectal cancer screening (3.54 percentage point change, < 0.001), and eye exams for adults with diabetes (3.56 percentage point change, = 0.008) had the largest performance declines. Equity of ambulatory care quality did not significantly change over time. The one exception was for breast cancer screening, where equity declined for Asian patients (3.52 percentage point change, = 0.04). Although equity of care generally did not significantly change over time across ACOs, high variation in equity of care performance between ACOs highlights opportunities to identify and share the strategies that enable physician practices and healthcare systems to advance equity of care for racial and ethnic minority patients.
关于 accountable care organization（ACO）在门诊医疗质量公平性方面的差异，现有的信息有限。我们研究了 2019 年至 2022 年期间，种族和族裔少数群体患者的医疗公平性是否发生了变化，以及随着时间的推移，马萨诸塞州 11 个 ACO 在医疗公平性表现方面的差异程度。我们分析了针对亚洲、黑人和西班牙裔患者的 8 项门诊医疗质量指标的 ACO 层面的医疗公平性变化，以每组与多数非西班牙裔白人患者组之间的百分点差异来衡量。宫颈癌筛查（变化 3.54 个百分点，<0.001）、结直肠癌筛查（变化 3.54 个百分点，<0.001）以及糖尿病成人患者的眼科检查（变化 3.56 个百分点，=0.008）的表现下降幅度最大。门诊医疗质量的公平性随时间没有显著变化。唯一的例外是乳腺癌筛查，亚洲患者的公平性有所下降（变化 3.52 个百分点，=0.04）。尽管总体而言，各 ACO 之间的医疗公平性随时间没有显著变化，但 ACO 之间在医疗公平性表现上的高度差异凸显了识别和分享相关策略的机会，这些策略能使医生执业机构和医疗保健系统促进种族和族裔少数群体患者的医疗公平性。
