The quality of migrant patients' primary healthcare experiences and patient-centered medical home achievement by community health centers: results from the China greater bay area study.

BACKGROUND: In China, Community Health Centers (CHCs) provide primary healthcare (PHC); however, few studies have examined the quality of PHC services experienced by migrant patients. We examined the potential association between the quality of migrant patients' PHC experiences and the achievement of Patient-Centered Medical Home by CHCs in China. METHODS: Between August 2019 and September 2021, 482 migrant patients were recruited from ten CHCs in China's Greater Bay Area. We evaluated CHC service quality using the National Committee for Quality Assurance Patient-Centered Medical Home (NCQA-PCMH) questionnaire. We additionally assessed the quality of migrant patients' PHC experiences using the Primary Care Assessment Tools (PCAT). General linear models (GLM) were used to examine the association between the quality of migrant patients' PHC experiences and the achievement of PCMH by CHCs, adjusting for covariates. RESULTS: The recruited CHCs performed poorly on PCMH1, Patient-Centered Access (7.2 ± 2.0), and PCMH2, Team-Based Care (7.4 ± 2.5). Similarly, migrant patients assigned low scores to PCAT dimension C-First-contact care-which assesses access (2.98 ± 0.03), and D-Ongoing care (2.89 ± 0.03). On the other hand, higher-quality CHCs were significantly associated with higher total and dimensional PCAT scores, except for dimensions B and J. For example, the total PCAT score increased by 0.11 (95% CI: 0.07-0.16) with each increase of CHC PCMH level. We additionally identified associations between older migrant patients (> 60 years) and total PCAT and dimension scores, except for dimension E. For instance, the average PCAT score for dimension C among older migrant patients increased by 0.42 (95% CI: 0.27-0.57) with each increase of CHC PCMH level. Among younger migrant patients, this dimension only increased by 0.09 (95% CI: 0.03-0.16). CONCLUSION: Migrant patients treated at higher-quality CHCs reported better PHC experiences. All observed associations were stronger for older migrants. Our results may inform future healthcare quality improvement studies that focus on the PHC service needs of migrant patients.

Associations between Primary Healthcare Experiences and Glycemic Control Status in Patients with Diabetes: Results from the Greater Bay Area Study, China.

Primary healthcare (PHC) plays an important role in diabetes management; community health centers (CHCs) serve as the main providers of PHC. However, few studies have discussed the association between the service quality of PHC and the effects of diabetes management. In this study, we explored the associations between experiences of PHC in CHCs and glycemic control status in patients with diabetes mellitus. This study was conducted in six CHCs in the Greater Bay Area of China. In total, 418 patients with diabetes mellitus (44% males and 56% females) were recruited between August and October 2019. We evaluated their PHC experiences using the Primary Care Assessment Tool (PCAT) developed by Johns Hopkins and assessed their glycemic control status by measuring their fasting plasma glucose levels. Binary logistic regression analyses were conducted to assess the associations between the patients' PHC experiences and glycemic control status, adjusting for covariates. The patients with good glycemic control had significantly higher total and dimensional PCAT scores compared with those with poor glycemic control (p < 0.05). Higher PCAT scores were significantly associated with a greater adjusted odds ratios (aORs) of good glycemic control for total and dimensional PCAT scores. For example, compared to those with poor glycemic control, the aORs for those with good glycemic control was 8.82 (95% CI = 4.38−17.76) per total PCAT score increasing. Especially, the aORs for those with good glycemic control were 3.92 (95% CI = 2.38−6.44) and 4.73 (95% CI = 2.73−8.20) per dimensional PCAT score of family-centeredness and community orientation increasing, respectively. Better PHC experiences were associated with better diabetes management. In particular, family-centered and community-oriented CHCs may help improve diabetes management in China and other low- and middle-income countries.

Association between resident status and patients' experiences of primary care: a cross-sectional study in the Greater Bay Area, China.

OBJECTIVES: Patients' experiences are important part of health services quality research, but it's still unclear whether patients' experiences are influenced by resident status. This study aimed to evaluate the association between resident status and patients' primary care experiences with the focus on migrants vs local residents. DESIGN: A cross-sectional study using multistage cluster random sampling was conducted from September to November 2019. The data were analysed using general linear models. SETTING: Six community health centres in Guangzhou, China. PARTICIPANTS: 1568 patients aged 20 years or older. MAIN OUTCOME MEASURES: Patients' primary care experiences were assessed using the Primary Care Assessment Tool. The 10 domains included in Primary Care Assessment Tool (PCAT) refers to first contact-utilisation, first contact-access, ongoing care, coordination (referral), coordination (information), comprehensiveness (services available), comprehensiveness (services provided), family-centredness, community orientation and cultural competence from patient's perspective. RESULTS: 1568 questionnaires were analysed. After adjusting for age, sex, education, annual family income, self-perceived health status, chronic condition, annual medical expenditure and medical insurance, the PCAT total scores of the migrants were significantly lower than those of local residents (ß=-0.128; 95% CI -0.218 to -0.037). Migrants had significantly lower scores than local residents in first contact utilisation (ß=-0.245; 95% CI -0.341 to -0.148), ongoing care (ß=-0.175; 95% CI -0.292 to -0.059), family-centredness (ß=-0.112; 95% CI -0.225 to 0.001), community orientation (ß=-0.176; 95% CI -0.286 to -0.066) and cultural competence (ß=-0.270; 95% CI -0.383 to -0.156), respectively. CONCLUSION: Primary care experiences of migrants were significantly worse off than those of local residents, especially in terms of primary care utilisation, continuity and cultural competence. Given the wide disparity in primary care experiences between migrants and local residents, Chinese healthcare system reform should focus on improving quality of primary care services for migrants, overcoming language barriers and creating patient-centred primary care services.

The institutional primary healthcare service quality and patients' experiences in Chinese community health centres: results from the Greater Bay Area study, China.

BACKGROUND: The goal of this paper was to assess the quality of primary healthcare services at community health centres (CHCs) from the demand (patient) and supplier (healthcare service institution) angles. METHODS: This study was conducted at six CHCs in the Greater Bay Area of China. Between August and October 2019, 1,568 patients were recruited (55.8% women and 44.2% men). We evaluated the service quality of CHCs using the National Committee for Quality Assurance Patient-Centred Medical Home (NCQA-PCMH) recognition questionnaire. We assessed patients' experiences with medical and health services using the Primary Care Assessment Tools (PCAT). RESULTS: PCAT total and sub-domains scores were significantly difference at the six CHCs (P < 0.001). Among the six CHCs, Shayuan CHC had the highest PCAT total and sub-domain scores and the highest NCQA-PCMH total and sub-domain scores, as well. Older (> 60 years), female, lower education, and employee medical-insured individuals had better patient experiences. CONCLUSIONS: Our results indicate that CHCs could improve their service quality by improving both institutional health service quality based on NCQA-PCMH assessment and patient experiences based on PCAT scales. These findings can help inform patient-centred primary healthcare policy and management.

Analysis of Traffic Crashes Caused by Motorcyclists Running Red Lights in Guangdong Province of China.

Motorcycles are among the primary means of transport in China, and the phenomenon of motorcyclists running red lights is becoming increasingly prevalent. Based on the traffic crash data for 2006-2010 in Guangdong Province, China, fixed- and random-parameter logit models are used to study the characteristics of motorcyclists, vehicles, roads, and environments involved in red light violations and injury severity resulting from motorcyclists' running red lights in China. Certain factors that affect the probability of motorcyclists running red lights are identified. For instance, while the likelihood of violating red light signals during dark conditions is lower than during light conditions for both car drivers and pedestrians, motorcyclists have significantly increased probability of a red light violation during dark conditions. For the resulting severe casualties in red-light-running crashes, poor visibility is a common risk factor for motorcyclists and car drivers experiencing severe injury. Regarding the relationship between red light violations and the severity of injuries in crashes caused by motorcyclists running red lights, this study indicated that driving direction and time period have inconsistent effects on the probability of red light violations and the severity of injuries. On the one hand, the likelihood of red light violations when a motorcycle rider is turning left/right is higher than when going straight, but this turning factor has a nonsignificant impact on the severity of injuries; on the other hand, reversing, making a U-turn and changing lanes have nonsignificant effects on the probability of motorcyclists' red light violations in contrast to going straight, but have a very significant impact on the severity of injuries. Moreover, the likelihood of red light violations during the early morning is higher than off-peak hours, but this time factor has a negative impact on the severity of injuries. Measures including road safety educational programs for targeted groups and focused enforcement of traffic policy and regulations are suggested to reduce the number of crashes and the severity of injuries resulting from motorcyclists running red lights.

Association between occupational health and safety knowledge and behaviours among migrant workers: results from a cross-sectional study in China.

OBJECTIVES: To assess the relationship between occupational health and safety (OH&S)-related behaviours of migrating workers in China and their knowledge regarding OH&S laws and regulations (L&Rs). MATERIALS AND METHODS: We sampled 1282 migrant workers from 12 labour-intensive manufacturers in Guangdong, China, with a response rate of 98.6%. Self-reported questionnaires were completed by the participants. Logistic regression models were used to examine the association between OH&S-related behaviours and knowledge among migrant workers adjusting for their demographic features and the survey sites. RESULTS: Migrant workers' behaviour of seeking occupational disease (OD) diagnosis and treatment was found to be statistically significantly correlated with their knowledge of all three OH&S L&Rs. A higher score of knowledge regarding these OH&S L&Rs is associated with a better chance to seek OD diagnosis and treatment. The ORs of the high-score group (subjects correctly answered more than one question) versus the low-score group (subjects correctly answered less than or equal to one question) are 2.02 (95% CI: 1.33 to 3.07) for Law of Occupational Disease Prevention and Treatment, 2.89 (95% CI: 1.65 to 5.09) for Regulations on Safe Management of Dangerous Chemicals and Regulations on Labor Protection for Using Toxic Substances in Workplace and 2.25 (95% CI: 1.34 to 3.77) for Work-Related Injury Insurance Regulations. However, knowledge about these L&Rs is not statistically significantly associated with OH&S-related protective behaviours such as wearing a mask or gloves at work. CONCLUSIONS: Knowledge of OH&S L&Rs helps migrant workers in China to seek OD diagnosis and treatment.

The association between the supply and utilization of community-based primary care and child health in a context of hospital-oriented healthcare system in urban districts of Guangdong, China: a panel dataset, 2014-2016.

BACKGROUND: Since 2009, the Chinese government has been reforming the healthcare system and has committed to reinforcing increased use of primary care. To date, however, the Chinese healthcare system is still heavily reliant on hospital-based specialty care. Studies consistently show an association between primary care and improved health outcomes, and the same association is also found among the disadvantaged population. Due to the "hukou" system, interprovincial migrants in the urban districts are put in a weak position and become the disadvantaged. Therefore, the aim of this study is to investigate whether greater supply and utilization of primary care was associated with reduced child mortality among the entire population and the interprovincial migrants in urban districts of Guangdong province, China. METHODS: An ecological study was conducted using a 3-year panel data with repeated measurements within urban districts in Guangdong province from 2014 to 2016, with 178 observations in total. Multilevel linear mixed effects models were applied to explore the associations. RESULTS: Higher visit proportion to primary care was associated with reductions in the infant mortality rate and the under-five mortality rate in both the entire population and the interprovincial migrants (p < 0.05) in the full models. The association between visit proportion to primary care and reduced neonatal mortality rate was significant among the entire population (p < 0.05) while it was insignificant among the interprovincial migrants (p > 0.05). CONCLUSIONS: Our ecological study based in urban districts of Guangdong province found consistent associations between higher visit proportion to primary care and improvements in child health among the entire population and the interprovincial migrants, suggesting that China should continue to strengthen and develop the primary care system. The findings from China adds to the previously reported evidence on the association between primary care and improved health, especially that of the disadvantaged.

The effects of gatekeeping on the quality of primary care in Guangdong Province, China: a cross-sectional study using primary care assessment tool-adult edition.

BACKGROUND: Developed countries have widely implemented a gatekeeping system as a core policy of primary care, also known as the system of first visit in the community. As gatekeepers, general practitioners are responsible for the diagnosis and treatment of residents in the community health centres, and referring patients to specialists as appropriate. After several years of healthcare reform, gatekeeping policy has achieved remarkable success in China. Shenzhen and Dongguan were the first batch of pilot cities that implemented the policy of gatekeeping. This study aims to examine the effects of gatekeeping on the quality of primary care between the gatekeeping and non-gatekeeping groups in these two pilot cities. METHODS: A cross-sectional survey was conducted in five community health centres in Shenzhen and Dongguan cities, both located within Guangdong Province, China, using a validated Chinese version of the Primary Care Assessment Tool-Adult Edition (PCAT-AE) and carrying out face-to-face interviews with patients 18 years and older. Analyses were grouped according to whether or not patients had gatekeepers. Propensity Score Matching was used to control for confounding factors. A chi-square test was used to compare the factors mentioned above and an independent t-test was performed to compare the eight domains of the core functions of primary care between the two groups of patients. RESULTS: In total, 765 valid questionnaires were collected for analysis, after matching the sample size were 238 pairs. All the confounding factors observed between the gatekeeping and non-gatekeeping groups were balanced. The PCAT-AE scores for first-contact utilisation (3.29 > 2.66, p < 0.001) and coordination (2.06 > 1.95, p < 0.05) were higher in the gatekeeping group after matching, but the domains of accessibility (1.59 < 1.67, p < 0.05) and continuity (2.26 < 2.40, p < 0.05) were lower. The PCAT-AE mean score was slightly higher in gatekeeping group (1.98 > 1.93, p > 0.05) but without statistical significance. CONCLUSION: This study demonstrated that gatekeeping has helped to improve first-contact utilisation and coordination of primary care, but that other goals such as continuity and comprehensiveness have been harmed. To establish a sustainable gatekeeping system and to strengthen the core functions of the community comprehensively, the current gatekeeping system needs refinement.

Comparing the needs and utilization of health services between urban residents and rural-to-urban migrants in China from 2012 to 2016.

BACKGROUND: With a large population of internal migrants from all over the world, China has the largest number of internal floating migrants, and most of them (up to 169 million in 2016) are rural-to-urban migrants. Those migrants have difficulty accessing essential health care services because of Hukou, leading to disparities in health needs and utilization between rural-to-urban migrants and residents. To compare the needs and utilization of health services between urban residents and rural-to-urban migrants in China from 2012 to 2016. METHOD: We used longitudinal data from the Chinese Labor Dynamic Survey (CLDS) with three waves in 2012, 2014 and 2016. Descriptive analysis was employed to show self-reported illnesses and health services utilization among locals and migrants in the most recent 2 weeks in China. Chi-square tests and log binomial regression models were constructed to explore factors influencing health care needs and utilization. RESULT: A total of 19.97% of respondents were rural-to-urban migrants, with an upward trend from 2012 to 2016. Rural-to-urban migrants (11.99%) had higher needs for health services than urban residents (10.47%) in general, while urban residents and migrants had no differences in needs in 2012. Besides, there was no difference in the utilization of health services between residents and migrants in 2012, 2014 or 2016. In addition, increased age, male sex, poor medical insurance coverage and dissatisfaction with income were found to have negative effects on health care needs. CONCLUSION: This study has shown that the rural-to-urban migrants had higher health care needs but the same health care utilization compared with urban residents in China. Health policies focusing on equitable health outcomes should pay more attention to rural-to-urban migrants in China's health care system reform.

The Association of Patient-centered Medical Home Designation With Quality of Care of HRSA-funded Health Centers: A Longitudinal Analysis of 2012-2015.

OBJECTIVES: (1) To evaluate the relationship between Patient-centered Medical Home (PCMH) recognition and quality of clinical care among health centers, and (2) to determine whether the duration of recognition is positively associated with cumulative quality improvement over time. METHODS: Data came from the 2012 to 2015 Uniform Data System, health centers' PCMH recognition status, and the Area Resource File. Health center was the unit of observation. The outcome variables included 11 measures of clinical quality. We pooled all years of data and modeled longitudinal data with generalized estimating equations to examine the degree of improvement in health care quality in health centers with and without PCMH recognition over the years 2012-2015. RESULTS: Health centers with PCMH recognition generally performed better on clinical quality measures than health centers that did not have PCMH recognition for all years studied. After accounting for health center and county-level potential confounders, health centers with longer periods of PCMH recognition were more likely to have improved their clinical quality on 9 of 11 measures, than health centers with fewer years of PCMH recognition. CONCLUSIONS: Health centers' length of time with PCMH recognition was positively associated with additive quality improvement. Adoption of the PCMH model of care may serve as a strategy to enhance quality of primary care services.

Access to and Disparities in Care among Migrant and Seasonal Farm Workers (MSFWs) at U.S. Health Centers.

OBJECTIVES: This study describes the characteristics of migrant and seasonal farm workers (MSFWs) served by federally-funded health centers and examines disparities in access to primary and preventive care between migrant health center (MHC) and community health center (CHC) program patients. METHODS: Cross-sectional analysis of the 2009 Health Center Patient Survey which has 2212 and 831 patients from CHC and MHC program patients, respectively. RESULTS: Our study showed that the MHC program provided comparable health care access and quality for MSFWs relative to CHC patients. However, there were challenges with access to primary care, such as getting timely medical and dental care and prescription medicine. DISCUSSION: These results affirmed the role of health centers in providing high-quality primary care and reducing disparities. However, continual efforts are needed to enhance access to and quality of care for MSFWs.

Types of health care facilities and the quality of primary care: a study of characteristics and experiences of Chinese patients in Guangdong Province, China.

BACKGROUND: In China, most people tend to use hospitals rather than health centers for their primary care generally due to the perception that quality of care provided in the hospital setting is superior to that provided at the health centers. No studies have been conducted in China to compare the quality of primary care provided at different health care settings. The purpose of this study is to compare the quality of primary care provided in different types of health care facilities in China. METHODS: A cross-sectional survey with patients was conducted in Guangdong province of China, using the validated Chinese Primary Care Assessment Tool (PCAT). ANOVA was performed to compare the overall and 10 domains of primary care quality for patients in tertiary, secondary, and primary health care settings. Multivariate analyses were used to assess the association between types of facility and quality of primary care attributes while controlling for sociodemographic and health care characteristics. RESULTS: The final number of respondents was 864 including 161 from county hospitals, 190 from rural community health centers (CHCs), 164 from tertiary hospitals, 80 from secondary hospitals, and 269 from urban CHCs. Type of health care facilities was significantly associated with total PCAT score and domain scores. CHC was associated with higher total PCAT score and scores for first contact-access, ongoing care, comprehensiveness-services available, and community orientation than secondary and/or tertiary hospitals, after controlling for patients' demographic and health characteristics. Higher PCAT score was associated with greater satisfaction with primary care received. CHC patients were more likely to report satisfactory experiences compared to patients from secondary and tertiary facilities. CONCLUSIONS: The study demonstrated that CHCs provided better quality primary care when compared with secondary and tertiary health care facilities, justifying CHCs as a model of primary care delivery.

Racial/Ethnic Disparities in Primary Care Quality Among Type 2 Diabetes Patients, Medical Expenditure Panel Survey, 2012.

INTRODUCTION: Racial and ethnic disparities exist in diabetes prevalence, access to diabetes care, diabetes-related complications and mortality rates, and the quality of diabetes care among Americans. We explored racial and ethnic disparities in primary care quality among Americans with type 2 diabetes. METHODS: We analyzed data on adults with type 2 diabetes derived from the household component of the 2012 Medical Expenditure Panel Survey. Multiple regression and multivariate logistic regressions were used to examine the association between race/ethnicity and primary care attributes related to first contact, longitudinality, comprehensiveness, and coordination, and clusters of confounding factors were added sequentially. RESULTS: Preliminary findings indicated differences in primary care quality between racial/ethnic minorities and whites across measures of first contact, longitudinality, comprehensiveness, and coordination. After controlling for confounding factors, these differences were no longer apparent; all racial/ethnic categories showed similar rates of primary care quality according to the 4 primary care domains of interest in the study. CONCLUSION: Results indicate equitable primary care quality for type 2 diabetes patients across 4 key domains of primary care after controlling for socioeconomic characteristics. Additional research is necessary to support these findings, particularly when considering smaller racial/ethnic groups and investigating outcomes related to diabetes.

General practitioners versus other physicians in the quality of primary care: a cross-sectional study in Guangdong Province, China.

BACKGROUND: The primary care in China can be provided by general practitioners (GPs) and other physicians (non-GPs). However, China's general practice system has never been really established. Chinese patients tend to consider the quality of primary care provided by GPs much lower than that of non-GPs. Besides, many GPs presently prefer leaving their own positions and seeking better development in big hospitals, which has made the already weak GP system weaker. Yet, few studies have specially compared the quality of primary care provided by Chinese GPs and other physicians and no studies have explored the independent predictors of Chinese GPs' intentions to stay on their current job. In this study, we aimed to compare the quality of primary care offered by GPs with non-GPs and to explore the independent predictors of GPs' future work intentions. METHODS: This cross-sectional study applied multi-stage random cluster sampling methodology. The data were collected from November 2013 to September 2014 in Guangdong Province. In total, 401 effective questionnaires were selected from the physicians. Quality of primary care was assessed using the Primary Care Assessment Tool (PCAT) Provider Part, representing six primary care domains: ongoing care, coordination (i.e., referrals and information systems), comprehensiveness (i.e., service available and service provided), family-centeredness, community orientation and cultural competence. RESULTS: Of 401 participating physicians, 163 (40.6 %) were GPs. The total PCAT score was 26.32 ± 2.24 which was the sum score of the six domains and represent the quality of primary care. GPs achieved significantly different total scores and scores on three individual scales: comprehensiveness: service available, comprehensiveness: service provided and community orientation. Multiple linear regressions revealed GPs had a higher total score and scores for comprehensiveness: service provided and community orientation after adjusting for sociodemographic characteristics. In addition, GPs were more likely to intend to stay in their current job in the coming year, and this was associated with their educational level. CONCLUSIONS: Our findings showed that GPs reported higher quality of primary care than other physicians, and were more inclined to stay in their current job. With more comprehensive care and community orientation provided by GPs, residents could reach basic medical cares and needn't to crowd into larger hospitals.

Usual source of care and the quality of primary care: a survey of patients in Guangdong province, China.

INTRODUCTION: Usual source of care (USC) refers to the provider or place a patient consults when sick or in need of medical advice. No studies have been conducted in China to compare the quality of primary care provided with or without USC. The purpose of this study was to fill this gap in the literature by examining the quality of primary care provided between those having a USC and those without. Results of the study would provide implications for policymakers in terms of improving primary care performance in China, and help guide patients in their health care seeking behaviors. METHODS: A cross-sectional survey with patients was conducted in Guangdong province of China, using the Chinese validated Primary Care Assessment Tool (PCAT). ANOVA was performed to compare the overall and ten domains of primary care quality for patients with and without USC. Multivariate analyses were used to assess the association between USC and quality of primary care attributes while controlling for sociodemographic and health care characteristics. RESULTS: The study added evidence that having a USC can provide higher quality of primary care to patients than those without a USC. Results of this study showed that the PCAT score associated with those having a USC was significantly higher than those not having a USC. Moreover, the study showed that having a usual provider of care was also independently and significantly associated with patients' satisfaction with care. CONCLUSIONS: This study added evidence that in China, patients with a USC reported higher quality of medical care experiences compared with those without a USC. The efforts to improve quality of care should include policies promoting USC.

Diabetes and medical expenditures among non-institutionalized U.S. adults.

AIMS: This research presents a comprehensive picture of medical spending associated with diabetes in the United States, accounting for important population characteristics. METHODS: The Household Component (HC) of the 2010 Medical Expenditure Panel Survey (MEPS) was used for this study. Regression analysis was used to compare medical spending between individuals with and without diabetes. The dependent variables of interest were total and out-of-pocket expenditures related to medical care, hospital use, physician office visits, and prescription drug use. RESULTS: This study reveals that individuals with diabetes experience significantly greater medical, hospital, physician office, and prescription drug expenditures compared to those without diabetes. Even after controlling for predisposing, enabling, and need factors, adults with diabetes spent $1843 more on total medical expenditures and $353 more on out-of-pocket medical expenditures than those without diabetes. Significant disparities were found in total and out-of-pocket expenditures by age, gender, education, race/ethnicity, and insurance status. CONCLUSIONS: Comprehensive interventions that focus on education and prevention should target individuals and communities at high-risk for diabetes and its complications. Our findings suggest that programs should focus on older Americans and those with poor health and mental health status.

Chronic conditions and medical expenditures among non-institutionalized adults in the United States.

INTRODUCTION: This study sought to examine medical expenditures among non-institutionalized adults in the United States with one or more chronic conditions. METHOD: Using data from the 2010 Medical Expenditure Panel Survey (MEPS) Household Component (HC), we explored total and out-of-pocket medical, hospital, physician office, and prescription drug expenditures for non-institutionalized adults 18 and older with and without chronic conditions. We examined relationships between expenditure differences and predisposing, enabling, and need factors using recent, nationally representative data. RESULTS: Individuals with chronic conditions experienced higher total spending than those with no chronic conditions, even after controlling for confounding factors. This relationship persisted with age. Out-of-pocket spending trends mirrored total expenditure trends across health care categories. Additional population characteristics that were associated with high health care expenditures were race/ethnicity, marital status, insurance status, and education. CONCLUSIONS: The high costs associated with having one or more chronic conditions indicates a need for more robust interventions to target population groups who are most at risk.

Racial and socioeconomic disparities in access to primary care among people with chronic conditions.

OBJECTIVE: The purpose of this study was to examine racial and socioeconomic disparities in access to primary care among people with chronic conditions. METHODS: Data for this study were taken from the household component of the 2010 Medical Expenditure Panel Survey. The analysis primarily focused on adults ≥ 18 years old. Logistic regressions were conducted among people with chronic conditions to compare primary care attributes between each minority group and their non-Hispanic white counterparts and between individuals with high, above average, or below average socioeconomic status and their low socioeconomic status counterparts, controlling for other individual factors. RESULTS: Racial disparities were found in having usual source of care (USC), USC provider type, and USC location. However, no disparities were found in ease of contacting or getting to USC as well as the services received. Furthermore, very limited socioeconomic disparities were found after controlling for other individual characteristics, in particular race and insurance status. CONCLUSIONS: More efforts need to be devoted to racial/ethnic minorities with chronic conditions to improve their access to continuous and high-quality primary care.

Insurance, racial/ethnic, SES-related disparities in quality of care among US adults with diabetes.

Diabetes-related quality improvement initiatives are typically aimed at improving outcomes and reducing complications. Studies have found that disparities in quality persist for certain racial/ethnic and socioeconomically disadvantaged groups; however, results are mixed with regard to insurance-based differences. The purpose of this study is to investigate the independent associations between type of health insurance coverage, race/ethnicity, and socioeconomic status (SES), and quality of care, as measured by benchmark indicators of diabetes-related primary care. This study used the Diabetes Care Survey of the 2010 Medical Expenditure Panel Survey. Bivariate and multivariate logistic regressions were used to examine the association between quality of diabetes care and type of insurance coverage, race/ethnicity, and SES. Multivariate analyses also controlled for additional demographic and health status characteristics. Respondents with insurance coverage (particularly those with private insurance or with Medicare and Medicaid coverage) were more likely to receive quality diabetes care than uninsured individuals. Few significant disparities based on race/ethnicity or SES persisted in subsequent multivariate analyses. Findings suggest that insurance coverage may make the greatest impact in ensuring equitable distribution of quality diabetes care, regardless of race/ethnicity or socioeconomic status. With the implementation of Affordable Care Act under which more people could potentially gain access to insurance, policymakers should next track insurance-based diabetes care disparities.