Racial and ethnic differences in clinical outcome trajectories for care managed patients.
Racial and ethnic differences in clinical outcome trajectories for care managed patients.
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DOI：
10.1097/mlr.0000000000000249
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发表时间：
2014-11
期刊：
影响因子：
3
通讯作者：
Dorr DA
中科院分区：
文献类型：
--
作者：
Quiñones AR;Ramsey K;Newsom JT;Dorr DA
护理管理已经证明，对于有复杂护理需求的患者，护理质量有所改善。这些干预措施在多大程度上有利于种族/少数民族人口尚不清楚。为了描述种族/民族的差异在纵向控制的临床结果的复杂护理需要的患者登记在护理管理+，一个卫生信息技术支持的护理协调干预。俄勒冈州和加利福尼亚州六个初级保健诊所在项目登记前后临床遭遇的重复观察的多层次模型。共对18675名临床患者进行了检查。我们分别对1481名和5320名反复测量血红蛋白A1c和血压的护理管理个体进行了多水平模型估计。主要结局是复杂护理患者的两项健康状况临床指标随时间的变化：(1)糖尿病患者的血红蛋白A1c，(2)中bp（平均收缩压和舒张压）。我们发现先前不受控制的A1c患者的A1c显著降低（期前斜率，b=1.03[0.83, 1.24]；期后斜率，b= - 0.63[- 0.91, - 0.35]）。对于中期bp，我们发现无条件周期前轨迹增加（b=3.52[2.39, 4.64]），周期后轨迹减少（b= - 5.21[- 5.70, - 4.72]）。我们还发现，黑人、拉丁裔和白人患者的A1c和中期血压的轨迹没有统计学差异。这些分析显示了一些有希望的中期临床结果为代表性不足的患者复杂的慢性护理需求。这些医疗保健系统的重新设计是否会给患者带来长期的好处，比如功能和生活质量的改善，还有待观察。
Care management has demonstrated improvements in quality of care for patients with complex care needs. The extent to which these interventions benefit race/ethnic minority populations is unclear. To characterize race/ethnic differences in the longitudinal control of clinical outcomes for patients with complex care needs enrolled in Care Management Plus, a health information technology-enabled care coordination intervention. Multilevel models of repeated observations from clinical encounters before and after program enrollment for six Oregon and California primary care clinics. A total of 18,675 clinic patients were examined. We estimated multilevel models for 1,481 and 5,320 care-managed individuals with repeated hemoglobin A1c and blood pressure measurements, respectively. Primary outcomes were changes over time for two clinical markers of health status for complex care patients: (1) hemoglobin A1c for patients with diabetes, and (2) mid-BP (average systolic and diastolic blood pressure). We found significant reductions in A1c for patients with previously uncontrolled A1c (pre-period slope, b=1.03 [0.83, 1.24]; post-period slope, b=−0.63 [−0.91, −0.35]). For mid-BP we found increasing unconditional pre-period trajectories (b=3.52 [2.39, 4.64]) and decreasing post-period trajectories (b=−5.21 [−5.70, −4.72]). We also found the trajectories of A1c and mid-BP were not statistically different for Black, Latino, and White patients. These analyses demonstrate some promising results for intermediate clinical outcomes for underrepresented patients with complex chronic care needs. It remains to be seen whether these health care system delivery redesigns yield long-term benefits for patients, such as improvements in function and quality of life.