Racial And Ethnic Disparities In Care Following The New York State Sepsis Initiative.
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ABSTRACT:
SUBMITTER: Corl K
PROVIDER: S-EPMC6814952 | biostudies-literature | 2019 Jul
REPOSITORIES: biostudies-literature
Publications
Racial And Ethnic Disparities In Care Following The New York State Sepsis Initiative.
Corl Keith K Levy Mitchell M Phillips Gary G Terry Kathleen K Friedrich Marcus M Trivedi Amal N AN
Health affairs (Project Hope) 20190701 7
After 2013, when New York State mandated that hospitals follow protocols to treat sepsis, completion of the protocols increased and mortality declined. Whether these encouraging trends have equitably benefited racial/ethnic minority populations is unknown. Although there were no significant racial/ethnic differences in rates of protocol completion at the onset of New York's Sepsis Initiative, over time white patients experienced a greater increase in protocol completion rates (14.0 percentage po ...[more]
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Project description:BackgroundIt remains unclear whether the racial-ethnic composition or the socioeconomic profiles of eligible primary care practices better explain practice participation in the Centers for Medicare and Medicaid Services' (CMS) Comprehensive Primary Care Plus (CPC+) program.ObjectiveTo examine whether practices serving high proportions of Black or Latino Medicare fee-for-service (FFS) beneficiaries were less likely to participate in CPC+ in 2021 compared to practices serving lower proportions of these populations.Design2019 IQVIA OneKey data on practice characteristics was linked with 2018 CMS claims data and 2021 CMS CPC+ participation data. Medicare FFS beneficiaries were attributed to practices using CMS's primary care attribution method.Participants11,718 primary care practices and 7,264,812 attributed Medicare FFS beneficiaries across 18 eligible regions.MethodsMultivariable logistic regression models examined whether eligible practices with relatively high shares of Black or Latino Medicare FFS beneficiaries were less likely to participate in CPC+ in 2021, controlling for the clinical and socioeconomic profiles of practices.Main measuresProportion of Medicare FFS beneficiaries attributed to each practice that are (1) Latino and (2) Black.Key resultsOf the eligible practices, 26.9% were CPC+ participants. In adjusted analyses, practices with relatively high shares of Black (adjusted odds ratio, aOR = 0.62, p < 0.05) and Latino (aOR = 0.32, p < 0.01) beneficiaries were less likely to participate in CPC+ compared to practices with lower shares of these beneficiary groups. State differences in CPC+ participation rates partially explained participation disparities for practices with relatively high shares of Black beneficiaries, but did not explain participation disparities for practices with relatively high shares of Latino beneficiaries.ConclusionsThe racial-ethnic composition of eligible primary care practices is more strongly associated with CPC+ participation than census tract-level poverty. Practice eligibility requirements for CMS-sponsored initiatives should be reconsidered so that Black and Latino beneficiaries are not left out of the benefits of practice transformation.
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