Where You Live Matters: Quality and Racial/Ethnic Disparities in Schizophrenia Care in Four State Medicaid Programs
Where You Live Matters: Quality and Racial/Ethnic Disparities in Schizophrenia Care in Four State Medicaid Programs
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DOI：
10.1111/1475-6773.12296
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发表时间：
2015-10-01
影响因子：
3.4
通讯作者：
Normand, Sharon-Lise T.
中科院分区：
文献类型：
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作者：
Horvitz-Lennon, Marcela;Volya, Rita;Normand, Sharon-Lise T.
Objective.确定（a）精神分裂症护理质量是否因种族/民族和时间而异，以及（B）这些模式是否因州内各县而异。Medicaid索赔数据来自加州、佛罗里达、纽约和北卡罗来纳州，2002- 2008年。我们研究了患有精神分裂症的黑人、拉丁裔和白色医疗补助受益人。分层回归模型，由国家，量化的人和县的种族/民族和年的综合质量指标的影响，调整人的水平特征。总体而言，我们的队列包括164，014人年（41- 61%非白人），相当于98，400名受益人。与白人相比，每个州的黑人质量都较低，拉丁美洲人的质量也较低，除了北卡罗来纳州。仅在加州和北卡罗来纳州观察到时间改善。在每个州内，县的质量和差距不同。在加州，黑人差异的县间差异大于拉丁裔差异的县间差异，而在北卡罗来纳州则较小;拉丁裔差异在佛罗里达没有因县而异。在每一个州，县在质量的年度变化不同;到2008年，没有县缩小了最初的合格率。对于生活在同一个州的医疗补助受益人来说，精神分裂症护理的质量和差异受到居住县的影响，原因超出了患者的特征。
Objective. To determine whether (a) quality in schizophrenia care varies by race/ethnicity and over time and (b) these patterns differ across counties within states.Data Sources. Medicaid claims data from California, Florida, New York, and North Carolina during 2002-2008.Study Design. We studied black, Latino, and white Medicaid beneficiaries with schizophrenia. Hierarchical regression models, by state, quantified person and county effects of race/ethnicity and year on a composite quality measure, adjusting for person-level characteristics.Principal Findings. Overall, our cohort included 164,014 person-years (41-61 percent non-whites), corresponding to 98,400 beneficiaries. Relative to whites, quality was lower for blacks in every state and also lower for Latinos except in North Carolina. Temporal improvements were observed in California and North Carolina only. Within each state, counties differed in quality and disparities. Between-county variation in the black disparity was larger than between-county variation in the Latino disparity in California, and smaller in North Carolina; Latino disparities did not vary by county in Florida. In every state, counties differed in annual changes in quality; by 2008, no county had narrowed the initial disparities.Conclusions. For Medicaid beneficiaries living in the same state, quality and disparities in schizophrenia care are influenced by county of residence for reasons beyond patients' characteristics.