Clinical care in Minnesota rebounded in 2021, but racial disparities remain

Clinical care proved more effective for minorities and traditionally underserved patients in the second year of the pandemic in Minnesota compared to the first.

That finding comes in a new report showing that disparities persisted in the management of diseases such as asthma and diabetes, but the decline in care was fairly uniform across racial and ethnic groups in 2020 — as was the recovery in 2021.

And in a few areas, such as adolescent mental health screening, care substantially improved — with depression screenings conducted for Hispanic adolescents in 89% of visits in 2021, compared to 81% in 2019. The progress narrowed the disparity with white adolescents, who were screened for depression in almost 92% of visits last year.

Even small percentage increases can mean thousands of lives changed for the better, said Julie Sonier, executive director of Minnesota Community Measurement, which released its annual disparities report Monday. "A couple of percentage points is a lot of people who are either getting better outcomes or better screening."

The report further illuminated the impact of the pandemic on clinical care in Minnesota. Among white adults, optimal management of vascular disease shifted from 61% among white patients in 2019 to 55% in 2020 to 57% in 2021. Among Black adults, optimal care swung from 46% to 41% to 44% in that timeframe.

In the absence of a COVID-19 vaccine in 2020, people reduced their social contacts to limit their chances of contracting the infectious disease — in some cases refraining from regular clinic visits or routine prescription refills at pharmacies.

A decline in clinical care scores was expected as a result, Sonier said, with the vascular disease score based on whether people took daily statin medications and aspirin, and kept their blood pressure down.

The latest report dispelled a concern that the rebound in scores in 2021 would only be among people with economic means — a group that is disproportionately white, Sonier said.

"It's not just the people with the most advantages that are the ones where you are seeing the recovery," Sonier said. "We are seeing it across the populations."

A forced reliance on telemedicine and virtual visits during the pandemic might have helped, providing easier access to care, particularly to low-income minorities with work, child care or transportation barriers to in-person visits, said Dr. Courtney Jordan Baechler, a preventive cardiologist with Allina Health.

"Telemedicine ... allows you very readily over the phone to up-titrate medications that control your blood pressure, control your blood sugar, control your cholesterol," she said. "These are things we can do very effectively in other ways beside face to face."

Allina maintained optimal vascular care for 50% of eligible Black patients last year, outperforming the rest of the state.

Minnesota Community Measurement is a non-profit group providing some of the most detailed data on disparities in clinical care in the nation. An appendix to the disparities report showed that some clinics performed better than others.

An elevated rate of colon cancer in Minnesota's Black population makes recommended screenings with colonoscopies or other means particularly important. But performance rates varied widely — with the Cedar Riverside People's Center only keeping 19% of eligible Black patients up to date on colon cancer screenings while Richfield Medical Group exceeded 76% last year.

Top scores weren't just among the largest, brand-name clinics in Minnesota, Sonier noted: "It's possible to be successful, regardless of where you are or how big you are."