Differences in Rates of High-Value and Low-Value Care Between Community Health Centers and Private Practices
Differences in Rates of High-Value and Low-Value Care Between Community Health Centers and Private Practices
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DOI：
10.1007/s11606-019-05544-z
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发表时间：
2019-11-19
影响因子：
5.7
通讯作者：
Fortuna, Robert J.
中科院分区：
文献类型：
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作者：
Oronce, Carlos Irwin A.;Fortuna, Robert J.
背景社区卫生中心(CHC)是卫生保健安全网的组成部分。随着卫生系统寻求提高价值，重要的是要了解社区卫生保健中心提供的护理质量。目的评价社区卫生服务机构与私人诊所在综合高价值和低价值护理措施方面的绩效。设计这项横断面研究使用了2010至2012年间全国门诊医疗保健调查的数据。我们使用Logistic回归模型对社区卫生服务机构和私人诊所进行了比较，这些模型根据年龄、性别、种族/民族、保险、慢性病数量、城乡位置、国家地区和调查年份进行了调整。地点/参与者我们纳入了18岁及以上患者去CHC或私人诊所看全科医生的情况。主要措施我们检查了12项高价值护理措施和7项低价值护理措施。结果从2010年到2012年，共有29,155位医生就诊，共584,208,173次加权就诊。与私人诊所相比，CHC更有可能通过订购β-受体阻滞剂(46.9%比36.5%；AOR 2.56；95%CI 1.18-5.56)、糖尿病患者的他汀类药物(37.0%比35.5%；AOR1.35；95%CI 1.02-1.79)以及提供骨质疏松症治疗(35.7%比23.2%；AOR1.77；95%CI 1.05-3.00)来提供高价值的护理。在一般体检中，CHC更有可能避免低值筛查EKG(98.7%比88.0%；AOR11.03；95%CI 2.67-45.52)、CBCs(75.9%比65.7%；AOR1.72；95%CI1.18-2.53)或尿检(86.0%比80.5%；AOR1.87；95%CI1.11-3.14)。CHC也不太可能为URI开抗生素(48.3%vs.63.1%；AOR 0.59；95%CI 0.40-0.88)。结论在许多高价值和低价值的护理措施上，社区卫生中心的表现与私人诊所相似或更好。随着医疗保健提供改革的继续推进，社区卫生保健机构处于有利地位，能够提供高价值的医疗保健。
Background Community health centers (CHCs) are an integral part of the health care safety net. As health systems seek to improve value, it is important to understand the quality of care provided by CHCs. Objective To evaluate the performance of CHCs compared with private practices on a comprehensive set of high-value and low-value care measures. Design This cross-sectional study used data from the National Ambulatory Medical Care Survey from 2010 through 2012. We compared CHCs with private practices using logistic regression models that adjusted for age, sex, race/ethnicity, insurance, number of chronic illnesses, rural versus urban location, region of country, and survey year. Setting/Participants We included outpatient visits to generalist physicians at either CHCs or private practices by patients 18 years and older. Main Measures We examined 12 measures of high-value care and 7 measures of low-value care. Results A total of 29,155 physician visits, representing 584,208,173 weighted visits, from 2010 through 2012 were included. CHCs were more likely to provide high-value care by ordering beta-blockers in CHF (46.9% vs. 36.5%; aOR 2.56; 95%CI 1.18-5.56), statins in diabetes (37.0% vs 35.5%; aOR 1.35; 95%CI 1.02-1.79), and providing treatment for osteoporosis (35.7% vs 23.2%; aOR 1.77; 95%CI 1.05-3.00) compared with private practices. CHCs were more likely to avoid low-value screening EKGs (98.7% vs. 88.0%; aOR 11.03; 95%CI 2.67-45.52), CBCs (75.9% vs. 65.7%; aOR 1.72; 95%CI 1.18-2.53), or urinalyses (86.0% vs. 80.5%; aOR 1.87; 95%CI 1.11-3.14) during a general medical exam. CHCs were also less likely to prescribe antibiotics for a URI (48.3% vs. 63.1%; aOR 0.59; 95%CI 0.40-0.88). Conclusions On a number of high-value and low-value measures of care, CHCs performed similar to or better than private practices. As healthcare delivery reforms continue to progress, CHCs are well positioned to provide high-value healthcare.