title: Have Racial Disparities in Ambulatory Care Sensitive Admissions Abated Over Time?
abstract: BACKGROUND
  Racial disparities in access to care and access to high-quality care have been persistent over many decades. They have been documented in all areas of health care, including ambulatory care. Policy initiatives have been implemented to address disparities and close the gaps in care that minorities face. Less is known about the effectiveness of these polices.
  
  
  OBJECTIVE
  To evaluate whether disparities in quality of ambulatory care have abated during the decade of 2000 by answering 2 questions: (1) were there differences in ambulatory care sensitive hospital admissions rates by race?; (2) have these differences been declining over time?
  
  
  METHODS
  Multivariable linear regressions with fixed county effects and robust SEs of longitudinal panel data.
  
  
  METHODS
  A total of 4,032,322 discharges in 172 counties in 6 states during 2003-2009.
  
  
  METHODS
  Prevention Quality Indicators (PQIs) developed by the Agency for Healthcare Research and Quality, by county, and race calculated from the Healthcare Cost and Utilization Project dataset.
  
  
  RESULTS
  In 2003 the overall PQI admission rates were higher for African Americans (around 16.5/1000) than for whites (around 15/1000). By 2009, the overall and the chronic PQI admission rates declined significantly (P<0.01) for whites. They either did not decline or increased for African Americans. Acute PQI rates declined significantly for whites and remained stable for African Americans.
  
  
  CONCLUSIONS
  Policies addressing persisting racial disparities in quality of ambulatory care for African Americans should focus on the chronic PQIs. In addition, efforts should be made to improve data quality for race and ethnicity information on hospital discharge data to enable informed policy evaluation and planning.
authors.affiliation: Departments of *Medicine, University of California, Irvine, CA †Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY ‡Agency for Healthcare Research and Quality, Rockville, MD.
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
authors.forename: Heather
authors.initials: H
authors.lastname: Ladd
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
authors.forename: Helena
authors.initials: H
authors.lastname: Temkin-Greener
authors.forename: Quyen
authors.initials: Q
authors.lastname: Ngo-Metzger
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016014:Linear Models; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012044:Regression Analysis; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data