Black patients have poorer outcomes on quality of care measurements in Medicare health plans

October 24, 2006

Black patients in Medicare managed care health plans often have poorer outcomes for treatment of common and important conditions such as high blood pressure, diabetes or high cholesterol, compared to white patients, according to a study in the October 25 issue of JAMA.

Eliminating disparities in health care is a fundamental component of the agenda to improve quality, according to background information in the article. Several performance reporting systems now report publicly on aspects of quality such as surgical outcomes, adherence to evidence-based quality measures, and patients' assessments of care, but few public reports about the quality of health care organizations have also assessed the equity of care provided by those organizations. Since 1997, all health plans participating in Medicare have reported on the quality of care using Health Plan Employer and Data Information Set (HEDIS) performance measures developed by the National Committee for Quality Assurance. The relationship between overall quality of care and racial disparities in quality has not been well studied.

Amal N. Trivedi, M.D., M.P.H., of Brown University, Providence, R.I., and colleagues at Harvard Medical School, conducted a study using multivariable models to assess variations among Medicare health plans in overall quality and racial disparity in 4 HEDIS outcome measures. The study sample included 431,573 individual-level observations in 151 Medicare health plans from 2002 to 2004. The researchers analyzed the outcome measures for hemoglobin A1c (a measurement of glucose) for enrollees with diabetes; low-density lipoprotein cholesterol levels for enrollees with diabetes or after a coronary event; and blood pressure levels for enrollees with hypertension.

The average performance on all 4 HEDIS outcome measures was significantly lower for black enrollees than white enrollees, with absolute percentage point differences ranging from 6.8 percent for blood pressure control to 14.4 percent for LDL-C control after a coronary event. For each measure, more than 70 percent of the racial disparity was attributable to within-plan disparity (different outcomes within the same health plan for white and black enrollees) and a much smaller proportion was due to between-plan disparity (disproportionate enrollment of black enrollees in lower-performing plans). Health plans varied substantially in both overall quality and racial disparity on each of the 4 outcome measures.

"The quality of care for Medicare managed care enrollees as assessed by HEDIS outcome measures is less than optimal, variable across health plans, and unequal by race. We observed no consistent relationship between overall performance and racial disparity in these outcome measures. High-quality health plans had racial disparities that were generally comparable in magnitude to low-quality plans, and only 1 plan demonstrated both high quality and low disparity for more than 1 outcome indicator. Furthermore, nationally observed racial disparities in outcomes were largely attributable to different outcomes for black and white enrollees within the same health plan rather than differences in the distribution of black and white enrollees across health plans," the authors write.

"Effective measurement within health plans is one cornerstone of improving quality and reducing racial disparities in outcomes. Such an approach is especially salient because health plans have both the fiduciary responsibility to enrollees to assure high-quality and equitable care and the management infrastructure to organize efforts to achieve these related goals. For the Medicare program, plan-specific performance reports that include information on equity would capture a dimension of quality not currently assessed by the HEDIS reporting system," the researchers conclude.
(JAMA. 2006;296:1998-2004. Available pre-embargo to the media at

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA or e-mail

The JAMA Network Journals

Related Diabetes Articles from Brightsurf:

New diabetes medication reduced heart event risk in those with diabetes and kidney disease
Sotagliflozin - a type of medication known as an SGLT2 inhibitor primarily prescribed for Type 2 diabetes - reduces the risk of adverse cardiovascular events for patients with diabetes and kidney disease.

Diabetes drug boosts survival in patients with type 2 diabetes and COVID-19 pneumonia
Sitagliptin, a drug to lower blood sugar in type 2 diabetes, also improves survival in diabetic patients hospitalized with COVID-19, suggests a multicenter observational study in Italy.

Making sense of diabetes
Throughout her 38-year nursing career, Laurel Despins has progressed from a bedside nurse to a clinical nurse specialist and has worked in medical, surgical and cardiac intensive care units.

Helping teens with type 1 diabetes improve diabetes control with MyDiaText
Adolescence is a difficult period of development, made more complex for those with Type 1 diabetes mellitus (T1DM).

Diabetes-in-a-dish model uncovers new insights into the cause of type 2 diabetes
Researchers have developed a novel 'disease-in-a-dish' model to study the basic molecular factors that lead to the development of type 2 diabetes, uncovering the potential existence of major signaling defects both inside and outside of the classical insulin signaling cascade, and providing new perspectives on the mechanisms behind insulin resistance in type 2 diabetes and possibly opportunities for the development of novel therapeutics for the disease.

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.

Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).

Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.

People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

Read More: Diabetes News and Diabetes Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to