Chin M H, Zhang J X, Merrell K
Section of General Internal Medicine, University of Chicago, Illinois 60637, USA.
Diabetes Care. 1998 Jul;21(7):1090-5. doi: 10.2337/diacare.21.7.1090.
To determine whether African-American Medicare recipients with diabetes are at increased risk for morbidity, poor quality of care, and high resource utilization.
We analyzed 1,376 patients with diabetes who were > or = 65 years of age and in the 1993 Medicare Current Beneficiary Survey. Morbidity measures were the Katz Index of Activities of Daily Living, Instrumental Activities of Daily Living, overall health perception, Charlson Comorbidity Index score, and diabetic complications. Quality of care standards were glycosylated hemoglobin measurements, ophthalmological visits, lipid testing, mammography, influenza vaccination, readmission within 30 days of hospital discharge, and outpatient visits within 4 weeks of hospital discharge. We stratified Medicare reimbursement by type of service and adjusted for sex, education, and age in multivariable analyses.
Compared with white patients, African-American patients had worse health perception and lower quality of care. They were more likely to visit the emergency department and had fewer physician visits per year. African-Americans had higher reimbursement for home health services, but total reimbursement was similar after case-mix adjustment.
Improved access to preventive care for older African-Americans with diabetes may improve health perception and use of the emergency department. The potential effect on total reimbursement is unclear. Future policy interventions to improve quality of care among Medicare patients with diabetes should especially target African-Americans.
确定患有糖尿病的非裔美国医疗保险受益人群是否有更高的发病风险、较差的医疗质量以及较高的资源利用率。
我们分析了1993年医疗保险当前受益人群调查中1376名年龄大于或等于65岁的糖尿病患者。发病指标包括卡茨日常生活活动指数、工具性日常生活活动、总体健康感知、查尔森合并症指数评分以及糖尿病并发症。医疗质量标准包括糖化血红蛋白测量、眼科就诊、血脂检测、乳房X光检查、流感疫苗接种、出院后30天内再入院以及出院后4周内门诊就诊。我们按服务类型对医疗保险报销进行分层,并在多变量分析中对性别、教育程度和年龄进行了调整。
与白人患者相比,非裔美国患者的健康感知较差,医疗质量较低。他们更有可能去急诊室就诊,且每年看医生的次数较少。非裔美国人在家庭健康服务方面的报销较高,但在病例组合调整后总报销相似。
改善老年非裔美国糖尿病患者获得预防性护理的机会可能会改善健康感知并减少急诊室的使用。对总报销的潜在影响尚不清楚。未来旨在提高医疗保险糖尿病患者医疗质量的政策干预措施应特别针对非裔美国人。