Across the U.S., more than 1,400 community health centers provide primary care services to underserved communities that might not otherwise have access to care. These health centers have also adopted a number of approaches to further reduce racial and ethnic disparities in care, including monitoring control of blood pressure in hypertension, control of blood sugar in diabetes, and low birthweight by race/ethnicity starting in 2008.
But a new study led by a Boston University School of Public Health (BUSPH) researcher found no evidence of either improved quality or reduced racial/ethnic disparities in diabetes control, hypertension control, or birthweight in community health center patients between 2009 and 2014.
The study was published in Journal of General Internal Medicine.
“The lack of change is somewhat surprising, given the substantial focus within health centers to eliminate health disparities,” says lead author Dr. Megan Cole, assistant professor of health law, policy & management at BUSPH. “We’ve also observed other changes over this time period that you’d think might be associated with improved outcomes, such as increased rates of insurance from the ACA and more widespread medical home participation.
The authors evaluated 1,047 centers for racial/ethnic time trends in quality outcomes between 2009 and 2014 and assessed disparities in diabetes control, blood pressure control, and birthweight both within and between centers.
The researchers found little evidence of reduced racial and ethnic health disparities, despite the fact that electronic health record adoption, medical home recognition, and insurance coverage rates increased substantially from 2009 to 2014. Two exceptions were increased rates for normal birthweight among black patients and decreased rates of diabetes control for white patients. Racial/ethnic disparities were found both within health centers — racial/ethnic differences were observed for patients served by the same health center, and between health centers — meaning minority patients were more likely to receive care at health centers where overall outcomes were worse.