Measuring racial disparities in the quality of ambulatory diabetes care.
BACKGROUND
Improving the health of minority patients who have diabetes depends in part on improving quality and reducing disparities in ambulatory care. It has been difficult to measure these components at the level of actionable units.


OBJECTIVE
To measure ambulatory care quality and racial disparities in diabetes care across groups of physicians who care for populations of ambulatory diabetes patients.


METHODS
Prospective cohort analysis using administrative data.


METHODS
Using fee-for-service Medicare claims data from 2003 to 2005, we link patients to their principal ambulatory care physician. The patients are then linked to the hospital where their physicians work or have their patients admitted, creating physician-hospital networks.


METHODS
Proportion of recommended diabetes testing received by black and nonblack diabetes patients.


RESULTS
Blacks received 70% of recommended care compared with nonblacks who received 76.9% (P < 0.001). However, for black and nonblack patients, variation in the quality of care exceeds the racial gap in treatment. The network-specific performance rates for blacks and nonblacks were highly correlated (r = 0.67, P < 0.001), but 47% of blacks, versus 31% of nonblacks, received care from the third of networks with lowest quality. Physician-hospital networks with higher overall quality, or patients with higher socioeconomic status, were no less likely to exhibit black-white disparities.


CONCLUSIONS
It is possible to measure, benchmark, and monitor the quality of minority care at the level of networks responsible for ambulatory care. Consequently, it should be easier to provide patients with information on network performance and to design policies that improve the quality of minority-serving providers.
Dartmouth Institute for Clinical Practice and Health Policy, Dartmouth Medical School, Hanover, NH 03766, USA. julie.bynum@dartmouth.edu
Julie P W
JP
Bynum
Elliott S
ES
Fisher
Yunjie
Y
Song
Jonathan
J
Skinner
Amitabh
A
Chandra
D000328:Adult; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D044383:Black People / Q000706:statistics & numerical data; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000628:therapy*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D006278:Medicare / Q000458:organization & administration*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D012044:Regression Analysis; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult; D001741:Black or African American