The association between clinical care strategies and the attenuation of racial/ethnic disparities in diabetes care - The translating research into action for diabetes (TRIAD) study
The association between clinical care strategies and the attenuation of racial/ethnic disparities in diabetes care - The translating research into action for diabetes (TRIAD) study
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DOI：
10.1097/01.mlr.0000237423.05294.c0
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发表时间：
2006-12-01
期刊：
影响因子：
3
通讯作者：
Brown, Arleen F.
中科院分区：
文献类型：
--
作者：
Duru, O. Kenrik;Mangione, Carol M.;Brown, Arleen F.
目的：我们试图确定管理式护理中更多地实施临床护理策略是否与糖尿病护理中已知的种族/民族差异的减弱有关。研究设计和方法：使用横断面数据，我们检查了7426名黑人、拉丁裔、亚太岛民和白人参与者在提供者组中登记的10项管理护理计划中的糖尿病护理质量，这些质量是通过过程交付频率和中间结果的药物管理来衡量的。我们根据提供者组水平的3种临床护理策略的强度对模型进行分层：医生提醒、医生反馈或糖尿病登记的使用。结果：提供者组水平对临床护理策略实施的暴露因种族和民族而异，10%的黑人参与者在提供者组中登记的医生反馈强度最高，10%的黑人和亚太岛民参与者登记在糖尿病登记使用强度最高的五分位数的小组中。尽管护理方面的差异得到了证实，尤其是黑人相对于白人受试者，但我们没有发现随着护理过程或中间结果的药物管理实施强度的增加，差异缩小的一致模式。结论：在大多数情况下，高强度实施糖尿病登记、医生反馈或医生提醒3临床护理策略类似于许多卫生保健环境中使用的策略，与管理型护理中糖尿病护理的已知差异的减弱无关。
Objective: We sought to determine whether greater implementation of clinical care strategies in managed care is associated with attenuation of known racial/ethnic disparities in diabetes care.Research Design and Methods: Using cross-sectional data, we examined the quality of diabetes care as measured by frequencies of process delivery as well as medication management of intermediate outcomes, for 7426 black, Latinos, Asian/Pacific Islanders, and white participants enrolled in 10 managed care plans wit in provider groups. We stratified models by intensity of 3 clinical care strategies at the provider group level: physician reminders, physician feedback, or use of a diabetes registry.Results: Exposure to clinical care strategy implementation at the provider group level varied by race and ethnicity, with < 10% of black participants enrolled in provider groups in the highest-intensity quintile for physician feedback and < 10% of both black and Asian/Pacific Islander participants enrolled in groups in the highest-intensity quintile for diabetes registry use. Although disparities in care were confirmed, particularly for black relative to white subjects, we did not find a consistent pattern of disparity attenuation with increasing implementation intensity for either processes of care or medication management of intermediate outcomes.Conclusions: For the most part, high-intensity implementation of a diabetes registry, physician feedback, or physician reminders, 3 clinical care strategies similar to those used in many health care settings, are not associated with attenuation of known disparities of diabetes care in managed care.