Disparities in the utilization of high-volume hospitals for complex surgery
Disparities in the utilization of high-volume hospitals for complex surgery
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DOI：
10.1001/jama.296.16.1973
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发表时间：
2006-10-25
影响因子：
120.7
通讯作者：
Ko, Clifford Y.
中科院分区：
文献类型：
--
作者：
Liu, Jerome H.;Zingmond, David S.;Ko, Clifford Y.
背景 对于已证实手术量与结果关系的手术，建议转诊至手术量大的医院。在低流量医院接受护理的患者的特征可能与在高流量医院接受护理的患者的特征不同。这些差异可能会限制他们在大容量医院获得或接受护理的能力。 目的 使用加利福尼亚州全州健康规划和发展办公室患者出院数据库，确定与使用大容量医院相关的患者特征。 设计、设置和参与者 对 2000 年至 2004 年期间接受以下住院手术的加利福尼亚人进行回顾性研究：选择性腹主动脉瘤修复术、冠状动脉旁路移植术、颈动脉内膜切除术、食管癌手术切除、髋部骨折修复、肺癌切除、心脏瓣膜置换、冠状动脉成形术、胰腺癌切除和全膝关节置换。主要结果指标是大手术量（年平均手术量最高的 20%）和小手术量（最低 20%）医院的患者种族/族裔和保险状况。结果 共有 719 608 名患者接受了 10 例手术中的 1 例。总体而言，在控制其他患者特征的情况下，非白人、医疗补助患者和未参保患者在高流量医院接受护理的可能性较小，而更有可能在低流量医院接受护理。黑人显着（ P
Context Referral to high-volume hospitals has been recommended for operations with a demonstrated volume-outcome relationship. The characteristics of patients who receive care at low-volume hospitals may be different from those of patients who receive care at high-volume hospitals. These differences may limit their ability to access or receive care at a high-volume hospital.Objective To identify patient characteristics associated with the use of high-volume hospitals, using California's Office of Statewide Health Planning and Development patient discharge database.Design, Setting, and Participants Retrospective study of Californians receiving the following inpatient operations from 2000 through 2004: elective abdominal aortic aneurysm repair, coronary artery bypass grafting, carotid endarterectomy, esophageal cancer resection, hip fracture repair, lung cancer resection, cardiac valve replacement, coronary angioplasty, pancreatic cancer resection, and total knee replacement.Main Outcome Measures Patient race/ethnicity and insurance status in high-volume ( highest 20% of patients by mean annual volume) and in low-volume ( lowest 20%) hospitals.Results A total of 719 608 patients received 1 of the 10 operations. Overall, non-whites, Medicaid patients, and uninsured patients were less likely to receive care at high-volume hospitals and more likely to receive care at low-volume hospitals when controlling for other patient-level characteristics. Blacks were significantly ( P