ACOs Serving High Proportions Of Racial And Ethnic Minorities Lag In Quality Performance
ACOs Serving High Proportions Of Racial And Ethnic Minorities Lag In Quality Performance
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DOI：
10.1377/hlthaff.2016.0626
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发表时间：
2017-01-01
期刊：
影响因子：
9.7
通讯作者：
Colla, Carrie H.
中科院分区：
文献类型：
--
作者：
Lewis, Valerie A.;Fraze, Taressa;Colla, Carrie H.
负责任的护理组织(ACO)的部分目的是提高卫生保健质量。然而，对于ACO如何影响差异，或者服务弱势患者的提供者在Medicare ACO合同下的表现，人们知之甚少。我们分析了ACO在医疗保健结果方面的种族和民族差异，以调查ACO患者中种族或少数民族成员所占比例与ACO在质量指标上的表现之间的关联。使用Medicare的数据和ACOs的全国调查，我们发现，少数族裔患者比例较高与33项Medicare质量绩效指标中的25项、两项疾病综合指标和整体质量综合指标的得分较低相关。然而，为少数族裔患者提供高份额服务的ACO在大多数可观察到的特征和能力方面与其他ACO相似，包括提供者组成、服务和临床能力。我们的研究结果表明，少数族裔患者比例较高的ACO可能在ACO合同下难以获得高质量的表现，特别是在他们参与的最初几年--维持或潜在地加剧目前的不平等。政策制定者必须考虑如何完善ACO计划，以鼓励为少数族裔患者服务的提供者的参与，并适当奖励表现。
Accountable care organizations (ACOs) are intended, in part, to improve health care quality. However, little is known about how ACOs may affect disparities or how providers serving disadvantaged patients perform under Medicare ACO contracts. We analyzed racial and ethnic disparities in health care outcomes among ACOs to investigate the association between the share of an ACO's patients who are members of racial or ethnic minority groups and the ACO's performance on quality measures. Using data from Medicare and a national survey of ACOs, we found that having a higher proportion of minority patients was associated with worse scores on twenty-five of thirty-three Medicare quality performance measures, two disease composite measures, and an overall quality composite measure. However, ACOs serving a high share of minority patients were similar to other ACOs in most observable characteristics and capabilities, including provider composition, services, and clinical capabilities. Our findings suggest that ACOs with a high share of minority patients may struggle with quality performance under ACO contracts, especially during their early years of participation-maintaining or potentially exacerbating current inequities. Policy makers must consider how to refine ACO programs to encourage the participation of providers that serve minority patients and to reward performance appropriately.