Racial and ethnic disparities in care for health system-affiliated physician organizations and non-affiliated physician organizations
Racial and ethnic disparities in care for health system-affiliated physician organizations and non-affiliated physician organizations
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DOI：
10.1111/1475-6773.13581
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发表时间：
2020-10-23
影响因子：
3.4
通讯作者：
Damberg, Cheryl L.
中科院分区：
文献类型：
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作者：
Timbie, Justin W.;Kranz, Ashley M.;Damberg, Cheryl L.
目的评估医疗保险按服务收费（FFS）受益人的种族和民族差异，以及卫生系统附属医生组织（PO）和非附属PO之间的差异是否存在差异。数据来源我们使用了医疗保险提供者实践和专业数据（MD-PPAS）、医疗保险提供者注册、连锁和所有权系统（PECOS）、IRS 990表格、100%医疗保险FFS索赔以及使用医疗保险贝叶斯改进姓氏地理编码2.0算法估计的种族/民族。研究设计使用2015年提供初级保健的16007个PO样本，我们评估了来自索赔的12项指标的种族/民族差异（2项癌症筛查;糖尿病眼科检查;护理连续性; 2项药物依从性指标; 3项急性护理后随访指标;全因急诊科（艾德）访视，全因再入院和门诊护理敏感入院）。我们使用PO随机效应模型将这些“总”差异分解为PO内和PO间分量。然后，我们将1853名隶属于卫生系统的PO与类似的非附属PO进行配对。我们通过每个非白人种族/民族与从属关系指标的相互作用，研究了从属关系状态下PO内差异的差异。数据收集/提取方法医疗保险关于提供者实践和专业的数据确定了医疗保险账单的PO; PECOS和IRS 990表格确定了卫生系统的隶属关系。受益人年龄18岁及以上归因于PO使用多个访问规则。主要研究结果我们观察到总的差距在12个白色和非白色受益人之间的36个比较，非白人得到更差的照顾在10个。PO内差异超过PO间差异，并且在12项比较中的9项中具有实质性重要性（>=5个百分点或>=0.2个标准化差异）。在这12名患者中，两项比较中，非附属PO的差异小于附属PO（P <0.05）：艾德访视后随访中黑人-白人差异小1.6个百分点，乳腺癌筛查中西班牙裔-白人差异小0.6个百分点。结论：我们没有发现证据表明，系统附属的PO有较小的种族和民族的差异比非附属PO。在存在差异的地方，附属参与组织的差异稍大。
Objective To assess racial and ethnic disparities in care for Medicare fee-for-service (FFS) beneficiaries and whether disparities differ between health system-affiliated physician organizations (POs) and nonaffiliated POs. Data Sources We used Medicare Data on Provider Practice and Specialty (MD-PPAS), Medicare Provider Enrollment, Chain, and Ownership System (PECOS), IRS Form 990, 100% Medicare FFS claims, and race/ethnicity estimated using the Medicare Bayesian Improved Surname Geocoding 2.0 algorithm. Study Design Using a sample of 16 007 POs providing primary care in 2015, we assessed racial/ethnic disparities on 12 measures derived from claims (2 cancer screenings; diabetic eye examinations; continuity of care; two medication adherence measures; three measures of follow-up visits after acute care; all-cause emergency department (ED) visits, all-cause readmissions, and ambulatory care-sensitive admissions). We decomposed these "total" disparities into within-PO and between-PO components using models with PO random effects. We then pair-matched 1853 of these POs that were affiliated with health systems to similar nonaffiliated POs. We examined differences in within-PO disparities by affiliation status by interacting each nonwhite race/ethnicity with an affiliation indicator. Data Collection/Extraction methods Medicare Data on Provider Practice and Specialty identified POs billing Medicare; PECOS and IRS Form 990 identified health system affiliations. Beneficiaries age 18 and older were attributed to POs using a plurality visit rule. Principal Findings We observed total disparities in 12 of 36 comparisons between white and nonwhite beneficiaries; nonwhites received worse care in 10. Within-PO disparities exceeded between-PO disparities and were substantively important (>=5 percentage points or>=0.2 standardized differences) in nine of the 12 comparisons. Among these 12, nonaffiliated POs had smaller disparities than affiliated POs in two comparisons (P < .05): 1.6 percentage points smaller black-white disparities in follow-up after ED visits and 0.6 percentage points smaller Hispanic-white disparities in breast cancer screening. Conclusions We find no evidence that system-affiliated POs have smaller racial and ethnic disparities than nonaffiliated POs. Where differences existed, disparities were slightly larger in affiliated POs.