Methods for Measuring Racial Differences in Hospitals Outcomes Attributable to Disparities in Use of High-Quality Hospital Care
Methods for Measuring Racial Differences in Hospitals Outcomes Attributable to Disparities in Use of High-Quality Hospital Care
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DOI：
10.1111/1475-6773.12514
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发表时间：
2017-04-01
影响因子：
3.4
通讯作者：
Liu, Chuan-Fen
中科院分区：
文献类型：
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作者：
Hebert, Paul L.;Howell, Elizabeth A.;Liu, Chuan-Fen
目的比较衡量高质量医院使用中种族/族裔差异的两种方法。数据源模拟数据。研究设计通过模拟，我们将评估少数族裔服务和非少数族裔服务医院的风险调整结果差异的少数族裔服务方法与固定效应方法进行比较，该固定效应方法估计如果医院中少数族裔和白人患者的分布相同，则不良结果的减少情况。我们评估了每种方法检测和衡量少数族裔患者在质量较差的医院接受护理所造成的结果差异的能力，我们将这种差异称为医院间差异，并在结果差异是由医院质量以外的因素引起时拒绝它。然而，固定效应方法有很多优点。它不需要对少数族裔服务的医院进行临时定义，并且准确地估计了差异的大小，而少数族裔服务的方法将差异低估了 35-46%。 结论 研究人员应考虑使用固定效应方法来衡量弱势群体在使用高质量医院护理方面的差异。
ObjectiveTo compare two approaches to measuring racial/ethnic disparities in the use of high-quality hospitals.Data SourcesSimulated data.Study DesignThrough simulations, we compared the minority-serving approach of assessing differences in risk-adjusted outcomes at minority-serving and non-minority-serving hospitals with a fixed-effect approach that estimated the reduction in adverse outcomes if the distribution of minority and white patients across hospitals was the same. We evaluated each method's ability to detect and measure a disparity in outcomes caused by minority patients receiving care at poor-quality hospitals, which we label a between-hospital disparity, and to reject it when the disparity in outcomes was caused by factors other than hospital quality.Principal FindingsThe minority-serving and fixed-effect approaches correctly identified between-hospital disparities in quality when they existed and rejected them when racial differences in outcomes were caused by other disparities; however, the fixed-effect approach has many advantages. It does not require an ad hoc definition of a minority-serving hospital, and it estimated the magnitude of the disparity accurately, while the minority-serving approach underestimated the disparity by 35-46 percent.ConclusionsResearchers should consider using the fixed-effect approach for measuring disparities in use of high-quality hospital care by vulnerable populations.