Racial and Ethnic Equity in Care for Hypertension and Diabetes in an Urban Indian Health Organization.
Racial and Ethnic Equity in Care for Hypertension and Diabetes in an Urban Indian Health Organization.
复制标题
印度城市卫生组织中高血压和糖尿病护理中的种族和民族平等。
DOI：
10.1007/s40615-022-01317-3
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发表时间：
2023
影响因子：
3.9
通讯作者：
Steiner,JohnF
中科院分区：
文献类型：
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作者：
Moore,KellyR;Schroeder,EmilyB;Goodrich,GlennK;Manson,SperoM;Malone,AllenS;Pieper,LisaE;Son-Stone,Linda;Johnson,David;Steiner,JohnF
大约70%的美国印第安人/阿拉斯加原住民（AI/AN）居住在城市地区。城市印第安人卫生组织（UIHO）为AI/AN患者和其他种族和族裔群体的成员提供文化参与的初级保健，他们在糖尿病和高血压护理方面经历了差异，并且通常受到社会和经济障碍的影响。我们评估了美国最大的UIHO所服务的种族和族裔群体之间是否存在差异。我们开发了一组接受该UIHO初级保健的高血压或糖尿病患者的回顾性队列，测量AI/AN、西班牙语偏好的Latinx、英语偏好的Latinx、黑人和白色患者在平均收缩压（SBP）和平均血红蛋白A1 c（A1 c）方面的差异作为主要结局。为了评估护理过程，我们还在根据社会人口统计学和临床特征调整的回归模型中比较了访视强度、漏访和药物治疗强度。对于高血压（n= 2148），校正的平均SBP范围为白人的135.8 mm Hg至黑人的141.3 mm Hg（p= 0.06）。对于糖尿病患者（n= 1211），调整后的A1 c范围从英语偏好拉丁裔的7.7%到黑人的8.7%（p= 0.38）。高血压和糖尿病的护理过程因组而异。没有一个群体持续接受低质量的护理。该UIHO为城市居住的AI/AN和其他种族，民族和语言偏好群体的成员提供了高血压和糖尿病的可比质量的护理。对UIHO的护理质量进行系统评估可能有助于证明其在提供护理和提高护理质量方面的重要作用。
Approximately 70% of American Indian/Alaska Native (AI/AN) individuals reside in urban areas. Urban Indian Health Organizations (UIHOs) provide culturally engaged primary care for AI/AN patients and members of other racial and ethnic groups who have experienced disparities in diabetes and hypertension care, and are commonly affected by social and economic barriers to care. We assessed whether disparities were present between the racial and ethnic groups served by the largest UIHO in the USA. We developed retrospective cohorts of patients with hypertension or diabetes receiving primary care from this UIHO, measuring differences between AI/AN, Spanish-preferring Latinx, English-preferring Latinx, Black, and White patients in mean systolic blood pressure (SBP) and mean hemoglobin A1c (A1c) as primary outcomes. To assess processes of care, we also compared visit intensity, missed visits, and medication treatment intensity in regression models adjusted for sociodemographic and clinical characteristics. For hypertension (n= 2148), adjusted mean SBP ranged from 135.8 mm Hg among Whites to 141.3 mm Hg among Blacks (p= 0.06). For diabetes (n= 1211), adjusted A1c ranged from 7.7% among English-preferring Latinx to 8.7% among Blacks (p= 0.38). Care processes for both hypertension and diabetes varied across groups. No group consistently received lower-quality care. This UIHO provided care of comparable quality for hypertension and diabetes among urban-dwelling AI/ANs and members of other racial, ethnic, and language preference groups. Systematic assessments of care quality in UIHOs may help demonstrate the importance of their role in providing care and improve the quality of care.