title: Racial and ethnic differences in clinical outcome trajectories for care managed patients.
abstract: BACKGROUND
  Care management has demonstrated improvements in quality of care for patients with complex care needs. The extent to which these interventions benefit race/ethnic minority populations is unclear.
  
  
  OBJECTIVE
  To characterize race/ethnic differences in the longitudinal control of clinical outcomes for patients with complex care needs enrolled in Care Management Plus, a health information technology-enabled care coordination intervention.
  
  
  METHODS
  Multilevel models of repeated observations from clinical encounters before and after program enrollment for 6 Oregon and California primary care clinics.
  
  
  METHODS
  A total of 18,675 clinic patients were examined. We estimated multilevel models for 1481 and 5320 care-managed individuals with repeated hemoglobin A1c and blood pressure measurements, respectively.
  
  
  METHODS
  Primary outcomes were changes over time for 2 clinical markers of health status for complex care patients: (1) hemoglobin A1c for patients with diabetes; and (2) mid-blood pressure (BP) (average systolic and diastolic blood pressure).
  
  
  RESULTS
  We found significant reductions in A1c for patients with previously uncontrolled A1c (preperiod slope, b=1.03 [0.83, 1.24]; postperiod slope, b=-0.63 [-0.91, -0.35]). For mid-BP we found increasing unconditional preperiod trajectories (b=3.52 [2.39, 4.64]) and decreasing postperiod trajectories (b=-5.21 [-5.70, -4.72]). We also found the trajectories of A1c and mid-BP were not statistically different for black, Latino, and white patients.
  
  
  CONCLUSIONS
  These analyses demonstrate some promising results for intermediate clinical outcomes for underrepresented patients with complex chronic care needs. It remains to be seen whether these health care system delivery redesigns yield long-term benefits for patients, such as improvements in function and quality of life.
authors.affiliation: *Department of Public Health & Preventive Medicine, Oregon Health & Science University †Portland VA Medical Center ‡School of Community Health §Institute on Aging, Portland State University ∥Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR.
authors.forename: Ana R
authors.initials: AR
authors.lastname: Quiñones
authors.forename: Katrina
authors.initials: K
authors.lastname: Ramsey
authors.forename: Jason T
authors.initials: JT
authors.lastname: Newsom
authors.forename: David A
authors.initials: DA
authors.lastname: Dorr
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D001794:Blood Pressure; D019090:Case Management; D003920:Diabetes Mellitus / Q000628:therapy; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D044469:Racial Groups / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human