Racial-Ethnic Composition of Primary Care Practices and Comprehensive Primary Care Plus Initiative Participation.
Racial-Ethnic Composition of Primary Care Practices and Comprehensive Primary Care Plus Initiative Participation.
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DOI：
10.1007/s11606-023-08160-0
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发表时间：
2023-10
影响因子：
5.7
通讯作者：
Rodriguez, Hector P.
中科院分区：
文献类型：
--
作者：
Rubio, Karl;Fraze, Taressa K.;Bibi, Salma;Rodriguez, Hector P.
关键词：
目前尚不清楚是否种族民族组成或社会经济概况合格的初级保健做法更好地解释实践参与医疗保险和医疗补助服务中心（CMS）综合初级保健加（CPC+）计划。研究为高比例的黑人或拉丁裔医疗保险按服务收费（FFS）受益人提供服务的做法是否与为这些人群提供较低比例服务的做法相比，不太可能在2021年参加CPC+。2019年IQVIA OneKey关于实践特征的数据与2018年CMS声明数据和2021年CMS CPC+参与数据相关联。医疗保险FFS受益人归因于使用CMS的初级保健归因方法的做法。11，718个初级保健实践和7，264，812个归因于18个合格地区的Medicare FFS受益人。多变量逻辑回归模型研究了黑人或拉丁裔医疗保险FFS受益人比例相对较高的合格实践是否不太可能在2021年参与CPC+，控制实践的临床和社会经济概况。属于每种做法的联邦医疗保险FFS受益人的比例是（1）拉丁美洲人和（2）黑人。在符合条件的实践中，26.9%是CPC+参与者。在调整后的分析中，与黑人（调整后的比值比，aOR = 0.62，p < 0.05）和拉丁美洲人（aOR = 0.32，p < 0.01）受益人比例相对较高的做法相比，这些受益人群体比例较低的做法参与CPC+的可能性较小。CPC+参与率的州差异部分解释了黑人受益人比例相对较高的做法的参与差异，但不能解释拉丁裔受益人比例相对较高的做法的参与差异。符合条件的初级保健做法的种族-民族构成与CPC+参与的关系比与人口普查区一级贫困的关系更密切。应该重新考虑CMS赞助的倡议的实践资格要求，以便黑人和拉丁美洲受益人不会被排除在实践转型的好处之外。 在线版本包含补充材料，可通过10.1007/s11606-023-08160-0获得。
It remains unclear whether the racial-ethnic composition or the socioeconomic profiles of eligible primary care practices better explain practice participation in the Centers for Medicare and Medicaid Services’ (CMS) Comprehensive Primary Care Plus (CPC+) program. To examine whether practices serving high proportions of Black or Latino Medicare fee-for-service (FFS) beneficiaries were less likely to participate in CPC+ in 2021 compared to practices serving lower proportions of these populations. 2019 IQVIA OneKey data on practice characteristics was linked with 2018 CMS claims data and 2021 CMS CPC+ participation data. Medicare FFS beneficiaries were attributed to practices using CMS’s primary care attribution method. 11,718 primary care practices and 7,264,812 attributed Medicare FFS beneficiaries across 18 eligible regions. Multivariable logistic regression models examined whether eligible practices with relatively high shares of Black or Latino Medicare FFS beneficiaries were less likely to participate in CPC+ in 2021, controlling for the clinical and socioeconomic profiles of practices. Proportion of Medicare FFS beneficiaries attributed to each practice that are (1) Latino and (2) Black. Of the eligible practices, 26.9% were CPC+ participants. In adjusted analyses, practices with relatively high shares of Black (adjusted odds ratio, aOR = 0.62, p < 0.05) and Latino (aOR = 0.32, p < 0.01) beneficiaries were less likely to participate in CPC+ compared to practices with lower shares of these beneficiary groups. State differences in CPC+ participation rates partially explained participation disparities for practices with relatively high shares of Black beneficiaries, but did not explain participation disparities for practices with relatively high shares of Latino beneficiaries. The racial-ethnic composition of eligible primary care practices is more strongly associated with CPC+ participation than census tract–level poverty. Practice eligibility requirements for CMS-sponsored initiatives should be reconsidered so that Black and Latino beneficiaries are not left out of the benefits of practice transformation. The online version contains supplementary material available at 10.1007/s11606-023-08160-0.
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