Roots of Health Disparities: The Quality of Primary Care

描述（由申请人提供）：许多研究表明，少数民族患者获得的医疗保健质量低于非少数民族患者。这些护理质量的差异是否是由于弱势患者在设施中接受护理或从提供较低质量护理的提供者那里接受护理，这是一个尚未充分探讨的重要问题 我们提出的研究有四个目的。(1)建立一个数据库，该数据库结合了从代表性调查中收集的美国医生代表性样本的信息，并与参加医疗保险计划的患者的信息相关联。(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，为每位患者分配护理过程和结果指标。这些进程将以预防为导向;其结果将是可能避免的住院治疗。p）通过评估内科医生特征与其个体患者的护理和结局之间的关联，评估医生水平的质量决定因素。(4)确定医生质量和医疗环境的差异在多大程度上导致健康差异。 这项研究将利用第三轮研究卫生系统变化医生调查中心收集的信息，以及医疗保险住院和门诊病人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亚选择性预防服务的比率，经历潜在可避免的住院治疗，以及他们的医生的特征和这些事件之间的关系。 我们有两个假设。(1)治疗少数民族患者的医生和治疗非少数民族患者的医生的特征之间存在很大差异，这些差异将与预测护理质量差异的因素有关。(2)当在控制这些差异的分析中进行评估时，将解释患者组之间的护理和结果的大多数差异。这些研究结果的意义在于，一个单一的方法来提高医生提供的护理质量，应该提高整体护理质量，减少医疗差距。

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.