Roots of Health Disparities: The Quality of Primary Care

描述(由申请人提供)：大量研究表明，少数族裔患者得到的医疗保健质量比非少数族裔患者差。这些护理质量的差异是由于脆弱的患者在医疗机构接受护理还是从提供较低质量护理的提供者那里得到的，这是一个尚未充分探讨的重要问题 我们提出的这项研究有四个目标。(1)汇编一个数据库，该数据库结合了从代表性调查中收集的具有代表性的美国医生样本的信息，并链接到他们参加联邦医疗保险计划的患者的信息。(2)通过将已建立和验证的算法应用于这些患者的医疗保险索赔，为每个患者分配护理过程和结果衡量标准。进程将以预防为导向；结果将是潜在地可以避免的住院治疗。P)通过评估医生特征与其个别患者的护理和结果之间的关系，在医生层面上评估质量的决定因素。(4)确定医生素质和医疗保健环境的差异在多大程度上导致健康差异。 这项研究将利用卫生系统变化研究中心第三轮医生调查期间收集的信息，以及联邦医疗保险住院患者和门诊患者c AIMS数据库中包含的丰富数据。使用这个链接的数据库，我们将评估患者接受次要预防服务的比率、可能避免的住院经历以及他们的医生特征与这些事件之间的关系。 我们有两个假设。(1)治疗少数族裔患者和非少数族裔患者的医生的特点会有很大差异，这些差异将与预测护理质量差异的因素有关。(2)在对提供者的这些差异进行控制的分析中进行评估时，将解释患者组之间在护理和结果方面的大多数差异。这些发现的意义在于，改善医生提供的护理质量的单一方法应该提高整体护理质量，减少医疗保健差距。

DESCRIPTION (provided by applicant): Numerous studies have demonstrated that minority patients receive poorer quality healthcare than non-minorities. Whether or not these differences in care quality are due to vulnerable patients receiving their care at facilities or from providers who provide lower quality care in general is an important question that lias been inadequately explored The study that we propose has four aims. (1) To assemble a database that combines information on a representative sample of US physicians gleaned from a representative survey, linked to information on their patients who ars enrolled in the Medicare program. (2) To assign process of care and outcome measures, to each patient by applying established and validated algorithms to these patients' Medicare claims. The processes will be oriented towards prevention; the outcomes will be potentially avoidable hospitalizations. p) To evaluate the determinants of quality at the physician level, by evaluating the association between pnysician characteristics and the care and outcomes of their individual patients. (4) To determine to what extent variations in physician quality and healthcare setting result in health disparities. This study will take advantage of information gleaned during Round 3 of the Center for Studying Health System Change Physician Survey, and also the rich data contained in Medicare inpatient and outpatient c aims databases. Using this linked database, we will assess the rates at which patients receive sub-opt mal preventive services, experience potentially avoidable hospitalizations, and the relation between their physician's characteristics and these events. We have two hypotheses. (1) That there will be large discrepancies between the characteristics of physicians treating minority patients and those treating non-minority patients, and these discrepancies will be associated with factors that predict differences in care quality. (2) When evaluated in analyses controlling for these differences in providers, most disparities in care and outcome between the patient groups will be explained. The significance of these findings would be that a singular approach to improving the quality of care provided by physicians should enhance care quality overall and reduce healthcare disparities.