HEALTH-CARE FOR BLACK AND POOR HOSPITALIZED MEDICARE PATIENTS
HEALTH-CARE FOR BLACK AND POOR HOSPITALIZED MEDICARE PATIENTS
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DOI：
10.1001/jama.271.15.1169
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发表时间：
1994-04-20
影响因子：
120.7
通讯作者：
KEELER, EB
中科院分区：
文献类型：
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作者：
KAHN, KL;PEARSON, ML;KEELER, EB
目的：考虑医院影响并使用经过验证的护理质量衡量标准，分析黑人或来自贫困社区的老年患者是否比其他患者接受更差的医院护理。设计。我们对入院时疾病、质量和结果的临床详细衡量指标进行简单和多变量比较，将向黑人或居住在贫困社区的参保、住院医疗保险患者提供的护理质量与其他患者进行比较。背景。设置 - 30 个地区的 297 家急症护理医院五个州。患者或其他参与者。-样本包括 9932 名 65 岁或以上患者的全国代表性样本，这些患者在因充血性心力衰竭、急性心肌梗死、肺炎或中风住院之前住在家中。干预措施。-这是一项观察性研究。主要结果指标。-护理过程、住院时间、出院时的不稳定、出院目的地和死亡率。结果。-在农村、城市非教学和城市教学内在医院中，黑人或来自贫困社区的患者比其他患者的护理过程更差，出院时更不稳定（P
Objective.-To analyze whether elderly patients who are black or from poor neighborhoods receive worse hospital care than other patients, taking account of hospital effects and using validated measures of quality of care.Design.-We compare quality of care provided to insured, hospitalized Medicare patients who are black or live in poor neighborhoods as compared with others, using simple and multivariable comparisons of clinically detailed measures of sickness at admission, quality, and outcomes.Setting.-Two hundred ninety-seven acute care hospitals in 30 areas within five states.Patients or Other Participants.-The sample includes a nationally representative sample of 9932 patients 65 years of age or older who lived at home prior to hospitalization for congestive heart failure, acute myocardial infarction, pneumonia, or stroke.Interventions.-This was an observational study.Main Outcome Measures.-Processes of care, length of stay, instability at discharge, discharge destination, and mortality.Results.-Within rural, urban nonteaching, and urban teaching hospitals, patients who are black or from poor neighborhoods have worse processes of care and greater instability at discharge than other patients (P