Race, ethnicity, socioeconomic position, and quality of care for adults with diabetes enrolled in managed care: the Translating Research Into Action for Diabetes (TRIAD) study
Race, ethnicity, socioeconomic position, and quality of care for adults with diabetes enrolled in managed care: the Translating Research Into Action for Diabetes (TRIAD) study
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DOI：
10.2337/diacare.28.12.2864
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发表时间：
2005-12-01
期刊：
影响因子：
16.2
通讯作者：
Beckles, GL
中科院分区：
文献类型：
--
作者：
Brown, AF;Gregg, EW;Beckles, GL
目的 - 调查管理式医疗环境中糖尿病护理的种族/族裔和社会经济差异。 研究设计和方法 - 我们研究了 7,456 名参加健康计划的成年人，他们参与了将研究转化为行动的糖尿病研究，这是一项关于管理式医疗中糖尿病的六中心队列研究。使用分层回归模型的横断面分析评估了护理过程（HbA(1C) [A1C]、血脂和蛋白尿评估；足部和散瞳检查；使用或建议使用阿司匹林和流感疫苗）和中间健康结果（A1C、LDL 和血压控制）。 结果 - 大多数质量指标和中间结果在种族/民族和社会经济地位 (SEP) 中具有可比性。拉丁裔和亚洲人/太平洋岛民的过程和中间结果与白人相似或更好，但 A1C 水平略高除外。与白人相比，非洲裔美国人的 A1C 和 LDL 测量以及流感疫苗接种率较低，足部和散瞳检查率较高，血压和血脂控制也最差。主要的 SEP 差异是较贫穷和受教育程度较低的个体进行散瞳检查的比率较低。几乎在所有情况下，血糖、血压和血脂控制不佳的少数种族/族裔或低 SEP 参与者都接受了与白人或 SEP 较高者相似或更适当的强化治疗。结论 - 在这些管理式医疗环境中，少数族裔/族裔并不总是与较差的过程或结果相关，而且并非所有差异都有利于白人。唯一显着的 SEP 差异是散瞳检查的比率。在管理式医疗环境中，健康方面的社会差异可能会减少。
OBJECTIVE - To examine racial/ethnic and socioeconomic variation in diabetes care in managed-care settings.RESEARCH DESIGN AND METHODS - We studied 7,456 adults enrolled in health plans participating in the Translating Research Into Action for Diabetes study, a six-center cohort study of diabetes in managed care. Cross-sectional analyses using hierarchical regression models assessed processes of care (HbA(1C) [A1C], lipid, and proteinuria assessment; foot and dilated eye examinations; use or advice to use aspirin-, and influenza vaccination) and intermediate health outcomes (A1C, LDL, and blood pressure control).RESULTS - Most quality indicators and intermediate outcomes were comparable across race/ethnicity and socioeconomic position (SEP). Latinos and Asians/Pacific Islanders had similar or better processes and intermediate outcomes than whites with the exception of slightly higher A1C levels. Compared with whites, African Americans had lower rates of A1C and LDL measurement and influenza vaccination, higher rates of foot and dilated eye examinations, and the poorest blood pressure and lipid control. The main SEP difference was lower rates of dilated eye examinations among poorer and less educated individuals. In almost all instances, racial/ethnic minorities or low SEP participants with poor glycemic, blood pressure, and lipid control received similar or more appropriate intensification of therapy relative to whites or those with higher SEP.CONCLUSIONS - In these managed-care settings, minority race/ethnicity was not consistently associated With worse processes or outcomes, and not all differences favored whites. The only notable SEP disparity was in rates of dilated eye examinations. Social disparities in health may be reduced in managed-care settings.