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

Abstract

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. To evaluate racial/ethnic time trends in quality outcomes in health centers and to assess both within- and between-center disparities in outcomes. 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. Percentage of patients achieving control of blood pressure<140/90mmHg among hypertensive persons, control of glycosylated hemoglobin ≤ 9.0% among diabetic persons, and birthweight ≥2500g. All outcomes were reported by race/ethnicity. 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). 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.