METHODS: Building on a previously published latent class analysis of 102 primary care clinics in Minnesota, we used multiple regression to establish relationships between IBH latent class and healthcare inequities in chronic disease management, and then structural equation modeling to examine how IBH latent class may moderate those healthcare inequities.
RESULTS: Contrary to our hypotheses, and demonstrating the complexity of the research question, clinics with better chronic disease management were more likely to be Low IBH rather than any other level of integration. Strong and Structural IBH clinics demonstrated better chronic disease management as race in the clinic\'s location became more White.
CONCLUSIONS: IBH may result in improved care, though it may not be sufficient to resolve healthcare inequities; it appears that IBH may be more effective when fewer social determinants of health are present. Clinics with Low IBH may not be motivated to engage in this practice change for chronic disease management and may need to be provided other reasons to do so. Larger systemic and policy changes are likely required that specifically target the mechanisms of healthcare inequities.
方法:建立在先前发表的明尼苏达州102个初级保健诊所的潜在类别分析的基础上,我们使用多元回归来建立IBH潜在类别与慢性病管理中医疗保健不平等之间的关系,然后进行结构方程建模,以研究IBH潜在类别如何缓解这些医疗保健不平等。
结果:与我们的假设相反,并证明了研究问题的复杂性,慢性病管理较好的诊所更可能是低IBH,而不是任何其他整合水平.强大的结构性IBH诊所表现出更好的慢性病管理,因为诊所位置的种族变得更加白化。
结论:IBH可能会改善护理,尽管这可能不足以解决医疗保健不平等;当存在较少的社会健康决定因素时,IBH似乎会更有效。低IBH的诊所可能没有动力参与这种慢性病管理的实践变化,可能需要提供其他原因。可能需要更大的系统性和政策变革,专门针对医疗保健不平等的机制。