Dataset Information

Longitudinal Analysis of Racial/Ethnic Trends in Quality Outcomes in Community Health Centers, 2009-2014.

ABSTRACT:

Background

To monitor progress towards eliminating health disparities, community health centers have reported on hypertension control, diabetes control, and birthweight by race and ethnicity since 2008.

Objective

To evaluate racial/ethnic time trends in quality outcomes in health centers and to assess both within- and between-center disparities in outcomes.

Design and sample

Using 2009-2014 data from all US health centers (n = 1047 centers, serving 19.6 million patients/year), we evaluated racial/ethnic time trends in quality outcomes for health centers and assessed within- and between-center disparities.

Main measures

Percentage of patients achieving control of blood pressure < 140/90 mmHg among hypertensive persons, control of glycosylated hemoglobin ? 9.0% among diabetic persons, and birthweight ? 2500 g. All outcomes were reported by race/ethnicity.

Key results

There was no evidence of improved outcomes among racial/ethnic subgroups from 2009 to 2014, though electronic health record adoption, medical recognition, and insurance coverage rates increased substantially. Two exceptions were increased rates of normal birthweight for black patients (87.0% to 88.8%, or 0.3 percentage points/year, p = 0.02) and decreased rates of diabetes control for white patients (74.2% to 69.5%, or -1.0 percentage points/year, p < 0.01). Within centers, the largest racial/ethnic disparities in 2009 were white/black disparities in hypertension control (8.7 percentage points, 95% CI 7.4-10.1), white/black disparities in diabetes control (3.4 percentage points, 95% CI 2.0-4.7), and white/Hispanic disparities in diabetes control (4.4 percentage points, 95% CI 2.8-6.0). All disparities remained statistically unchanged from 2009 to 2014. White patients were more likely to be seen at a health center in the top performance quintile compared with black and Hispanic patients (p < 0.001).

Conclusions

Though quality outcomes in health centers continued to compare favorably to other care settings, we found no evidence of improved quality or reduced disparities in diabetes control, hypertension control, or birthweight from 2009 to 2014. Within- and between-center racial/ethnic disparities in quality were evident, and both should be targeted in future interventions.

SUBMITTER: Cole MB

PROVIDER: S-EPMC5975141 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Longitudinal Analysis of Racial/Ethnic Trends in Quality Outcomes in Community Health Centers, 2009-2014.

Cole Megan B MB Wright Brad B Wilson Ira B IB Galárraga Omar O Trivedi Amal N AN

Journal of general internal medicine 20180216 6

<h4>Background</h4>To monitor progress towards eliminating health disparities, community health centers have reported on hypertension control, diabetes control, and birthweight by race and ethnicity since 2008.<h4>Objective</h4>To evaluate racial/ethnic time trends in quality outcomes in health centers and to assess both within- and between-center disparities in outcomes.<h4>Design and sample</h4>Using 2009-2014 data from all US health centers (n = 1047 centers, serving 19.6 million patients/yea ...[more]

PMID: 29453528

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Project description:ImportanceWith increasing efforts to create a diverse physician workforce that is reflective of the demographic characteristics of the US population, it remains unclear whether progress has been made since 2009, when the Liaison Committee on Medical Education set forth new diversity accreditation guidelines.ObjectiveTo examine demographic trends of medical school applicants and matriculants relative to the overall age-adjusted US population.Design, setting, and participantsRepeated cross-sectional study of Association of American Medical Colleges data on self-reported race/ethnicity and sex of medical school applicants and matriculants compared with population distribution of the medical school-aged population (20-34 years). Data from US allopathic medical school applicants and matriculants from 2002 to 2017 were analyzed.Main outcomes and measuresTrends were measured using the representation quotient, the ratio of the proportion of a racial/ethnic group in the medical student body to the general age-matched US population. Linear regression estimates were used to evaluate the trend over time for Asian, black, white, Hispanic, American Indian or Alaska Native (AIAN), and Native Hawaiian or Other Pacific Islander medical school matriculants by sex.ResultsThe number of medical school applicants increased 53%, from 33 625 to 51 658, and the number of matriculants increased 29.3%, from 16 488 to 21 326, between 2002 and 2017. During that time, proportions of black, Hispanic, Asian, and Native Hawaiian or Other Pacific Islander male and female individuals aged 20 to 34 years in the United States increased, while proportions of white male and female individuals decreased and proportions of AIAN male and female individuals were stable. From 2002 to 2017, black, Hispanic, and AIAN applicants and matriculants of both sexes were underrepresented, with a significant trend toward decreased representation for black female applicants from 2002 to 2012 (representation quotient slope, -0.011; 95% CI, -0.015 to -0.007; P < .001).Conclusions and relevanceBlack, Hispanic, and AIAN students remain underrepresented among medical school matriculants compared with the US population. This underrepresentation has not changed significantly since the institution of the Liaison Committee of Medical Education diversity accreditation guidelines in 2009. This study's findings suggest a need for both the development and the evaluation of more robust policies and programs to create a physician workforce that is demographically representative of the US population.

Dataset Information

Longitudinal Analysis of Racial/Ethnic Trends in Quality Outcomes in Community Health Centers, 2009-2014.

Background

Objective

Design and sample

Main measures

Key results

Conclusions

Publications

Longitudinal Analysis of Racial/Ethnic Trends in Quality Outcomes in Community Health Centers, 2009-2014.

Similar Datasets

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