Racial variations in quality of care and outcomes in an ambulatory heart failure cohort
Racial variations in quality of care and outcomes in an ambulatory heart failure cohort
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DOI：
10.1016/j.ahj.2005.12.004
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发表时间：
2006-08-01
影响因子：
4.8
通讯作者：
Beyth, Rebecca
中科院分区：
文献类型：
--
作者：
Deswal, Anita;Petersen, Nancy J.;Beyth, Rebecca
背景：最近很少有研究表明，黑人和白色心力衰竭（HF）住院患者的护理质量相似。然而，在门诊环境中，需要对护理质量和结果的种族差异进行系统评价，在大多数HF患者接受治疗的地方，护理可能更加分散。2010年10月至2011年10月在退伍军人事务部医疗中心接受治疗的18611例非卧床HF患者的全国队列中，结果黑人患者比白人患者更容易进行左室射血分数评估（风险调整OR为1.29，95% CI为1.11-1.49）。在左心室射血分数<40%的患者中，黑人和白人一样可能接受血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂（风险调整OR 1.06，95% CI 0.85-1.33）和β受体阻滞剂（风险调整OR 0.92，95% CI 0.79-1.07）治疗。然而，黑人患者更经常患有不受控制的高血压，更有可能因任何原因住院（OR 1.20，95% CI 1.08-1.33）或HF（OR 1.43，95% CI 1.23-1.66），尽管1年死亡率在人种间无差异结论在经济上“平等获得”的医疗保健系统中，通过选择质量指标评估的门诊HF护理质量和1年死亡率在黑人与白色患者中相似。然而，黑人更有可能住院，尤其是HF。识别和瞄准潜在的可改变因素，如黑人患者不受控制的高血压，可能会缩小住院治疗的种族差距。
Background Few recent studies have demonstrated similar quality of care for hospitalized black and white patients with heart failure (HF). However, systematic evaluation of racial differences in both the quality of care and outcomes is needed in the outpatient setting, where most patients with HF are treated and where care may be more fragmented.Methods We examined racial differences in quality-of-care measures and outcomes of 1-year mortality and hospitalization in a national cohort of 18 611 ambulatory patients with HF treated at Veterans Affairs medical centers between October 2000 and September 2002.Results Black patients were more likely to have left ventricular ejection fraction assessment than whites (risk-adjusted OR 1.29, 95% CI 1.11-1.49). In patients with left ventricular ejection fraction < 40%, blacks were as likely as whites to be on treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (risk-adjusted OR 1.06, 95% CI 0.85-1.33) and beta-blockers (risk-adjusted OR 0.92, 95% CI 0.79-1.07). However, black patients more frequently had uncontrolled hypertension and were more likely to be hospitalized for any cause (OR 1.20, 95% CI 1.08-1.33) or for HF (OR 1.43, 95% CI 1.23-1.66), although 1-year mortality did not differ by race (OR 1.03, 95% CI 0.89-1.20).Conclusions In a financially "equal access" health care system, the quality of outpatient HF care assessed by select quality measures and 1-year mortality was similar in black compared to white patients. However, blacks were more likely to be hospitalized, especially with HF. Identifying and targeting potentially modifiable factors such as uncontrolled hypertension in black patients may narrow the racial gap in hospitalizations.