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Racial/Ethnic Differences in Clinical Quality Performance Among Health Centers

Lebrun, Lydie A. PhD, MPH; Shi, Leiyu DrPH, MBA, MPA; Zhu, Jinsheng MEc; Sharma, Ravi PhD; Sripipatana, Alek PhD, MPH; Hayashi, A. Seiji MD, MPH; Daly, Charles A. MHA; Ngo-Metzger, Quyen MD, MPH

Journal of Ambulatory Care Management: January/March 2013 - Volume 36 - Issue 1 - p 24–34
doi: 10.1097/JAC.0b013e3182473523
Original Articles

More than 1100 federally funded health centers provide primary and preventive care to about 20 million underserved patients in the United States. Since 2008, the Health Resources and Services Administration has implemented a clinical quality improvement initiative to measure and evaluate the quality of care across all health centers. We assessed racial/ethnic disparities in clinical quality among US health centers, and examined whether performance on quality measures varied across 3 health center characteristics. National data came from the 2009 Uniform Data System. We examined performance across 3 indicators of clinical quality: poorly controlled hypertension among adult patients, poorly controlled diabetes among adult patients, and low birth weight among newborns. We compared results for each measure across racial/ethnic groups, as well as across 3 health center characteristics: health center patient volume, duration of health center funding, and extent of managed care penetration. Non-Hispanic Asian patients had the best results among racial/ethnic groups for 2 of the 3 measures examined: lowest rates of poorly controlled diabetes (26%) and hypertension (34%). Hispanics/Latinos had similar rates of poor hypertension control compared with non-Hispanic whites (38% for both), and lower rates of low birth weight (8% vs 10%). Poor diabetes control was more prevalent among Hispanic/Latino patients than non-Hispanic white patients, but the absolute difference was small (5 percentage points). Non-Hispanic black/African American patients had statistically worse outcomes than non-Hispanic white patients, but the absolute differences were also small (2–6 percentage points, depending on outcome). Health centers with larger patient volume fared better than their counterparts with smaller volume for all racial/ethnic groups. For Hispanic/Latino patients, more established health centers compared favorably to new health centers for all 3 outcomes. Health centers with some managed care penetration did better for diabetes and hypertension control relative to health centers without managed care penetration. Compared with national rates, health centers report minimal racial/ethnic disparities in clinical outcomes. Health center characteristics are also associated with clinical outcomes. More research is needed to determine the nature of disparities after accounting for health center patient, provider, and institutional characteristics.

Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland (Drs Lebrun, Sharma, Sripipatana, Hayashi, and Ngo-Metzger, and Mr Daly); Johns Hopkins Primary Care Policy Center, Baltimore, Maryland (Dr Shi and Ms Zhu).

Correspondence: Lydie A. Lebrun, PhD, MPH, US Department of Health & Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality and Data, 5600 Fishers Lane, 6A-55, Rockville, MD 20857 (

This study received financial support from the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) (Contract No. HHSH250200646022I).

The views expressed in this article are those of the authors and do not necessarily reflect the official policies of HHS or HRSA, nor does mention of the department or agency imply endorsement by the US government.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

© 2013 Lippincott Williams & Wilkins, Inc.