Do Racial/Ethnic Disparities in Quality and Patient Experience within Medicare Plans Generalize across Measures and Racial/Ethnic Groups?
Do Racial/Ethnic Disparities in Quality and Patient Experience within Medicare Plans Generalize across Measures and Racial/Ethnic Groups?
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DOI：
10.1111/1475-6773.12297
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发表时间：
2015-12-01
影响因子：
3.4
通讯作者：
Gaillot, Sarah
中科院分区：
文献类型：
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作者：
Weech-Maldonado, Robert;Elliott, Marc N.;Gaillot, Sarah
Objective.研究Medicare Advantage（MA）计划中不同指标在临床质量（医疗保健有效性数据和信息集[HEDIS]）和患者体验（医疗保健提供者和系统的消费者评估[CAHPS]）指标中的相似种族/民族差异。数据来源/研究设置。5.7 2008-2009年HEDIS/CAHPS数据的千年生态系统评估受益人。二项式（HEDIS）和线性（CAHPS）分层混合模型生成的合同估计HEDIS/CAHPS措施，西班牙裔，黑人，亚太岛民和白人。我们研究了HEDIS和CAHPS措施跨措施的计划内差异的相关性。针对特定少数群体（相对于白人）的特定措施存在差异的计划，对于同一类型的其他措施，存在类似差异的趋势适中（平均r = 0.51/。CAHPS/HEDIS的阳性率分别为21%和53/34%，具有统计学显著性）。这种模式在较小程度上适用于CAHPS差异和HEDIS差异的相关性（平均r = 0.05/0.14/0.23和4.4/5.6/4.4%），对于黑人/西班牙裔/API来说是正的和统计学显著的。CAHPS和HEDIS之间的相似之处可能反映了共同的结构性因素，如语言服务或提供者的激励措施，同时影响到几个措施。健康计划结构性变化可能会减少多项措施之间的差异。
Objective. To examine how similar racial/ethnic disparities in clinical quality (Healthcare Effectiveness Data and Information Set [HEDIS]) and patient experience (Consumer Assessment of Healthcare Providers and Systems [CAHPS]) measures are for different measures within Medicare Advantage (MA) plans.Data Sources/Study Setting. 5.7 million/492,495 MA beneficiaries with 2008-2009 HEDIS/CAHPS data.Study Design. Binomial (HEDIS) and linear (CAHPS) hierarchical mixed models generated contract estimates for HEDIS/CAHPS measures for Hispanics, blacks, Asian-Pacific Islanders, and whites. We examine the correlation of within-plan disparities for HEDIS and CAHPS measures across measures.Principal Findings. Plans with disparities for a given minority group (vs. whites) for a particular measure have a moderate tendency for similar disparities for other measures of the same type (mean r = 0.51/. 21 and 53/34 percent positive and statistically significant for CAHPS/HEDIS). This pattern holds to a lesser extent for correlations of CAHPS disparities and HEDIS disparities (mean r = 0.05/0.14/0.23 and 4.4/5.6/4.4 percent) positive and statistically significant for blacks/Hispanics/API.Conclusions. Similarities in CAHPS and HEDIS disparities across measures might reflect common structural factors, such as language services or provider incentives, affecting several measures simultaneously. Health plan structural changes might reduce disparities across multiple measures.