Are African American Patients More Likely to Receive a Total Knee Arthroplasty in a Low-quality Hospital?
Are African American Patients More Likely to Receive a Total Knee Arthroplasty in a Low-quality Hospital?
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DOI：
10.1007/s11999-011-2032-6
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发表时间：
2012-04-01
影响因子：
4.2
通讯作者：
Vaughan-Sarrazin, Mary
中科院分区：
文献类型：
--
作者：
Cai, Xueya;Cram, Peter;Vaughan-Sarrazin, Mary
全关节置换术广泛应用于所有种族的严重骨关节炎患者。此前的研究报告称，与白人患者相比，非裔美国患者倾向于在低容量医院接受全关节置换术，这表明关节置换术护理质量存在潜在的种族差异。我们询问（1）风险调整后死亡率或并发症的医院结局指标初次全膝关节置换术后90天内的并发症发生率可以直接用于评估医院护理质量，非裔美国人更可能在低质量医院接受TKA我们开发了一种风险调整后的90天术后结局指标，以根据7月1日至2010年7月30日期间医疗保险提供者分析和审查文件中的患者记录来识别高、中、低质量医院。2002年和2005年6月30日（第一批）。然后，我们分析了第二组接受医疗保险的非裔美国人和白人患者，他们在2005年7月至12月期间接受了初次TKA，以确定种族对高、中、低质量医院入院的独立影响，风险调整后的术后死亡率/并发症发生率在不同医院之间差异很大;医院可以有意义地分为质量组。在第二个入院队列中，8%的非裔美国人患者（n = 4894）和9.2%的白人患者（n = 86，705）在高质量医院接受治疗，而14.7%的非裔美国人患者和12.7%的白人患者在低质量医院接受治疗。在控制了患者的人口统计学、社会经济学、地理和诊断特征后，非裔美国患者与白人患者相比，进入低质量医院的优势比为1.28（95% CI，1.18-1.41）。在接受TKA的老年医疗保险受益人中，非裔美国人患者比白人患者更有可能入院，其风险调整后的术后并发症或死亡率更高。未来的工作是需要解决的住宅，社会和引用的因素，这种差异和影响的结果照顾。
Total joint arthroplasty is widely performed in patients of all races with severe osteoarthritis. Prior studies have reported that African American patients tend to receive total joint arthroplasties in low-volume hospitals compared with Caucasian patients, suggesting potential racial disparity in the quality of arthroplasty care.We asked whether (1) a hospital outcome measure of risk-adjusted mortality or complication rate within 90 days of primary TKA can be directly used to profile hospital quality of care, and (2) African Americans were more likely to receive TKAs at low-quality hospitals (or hospitals with higher risk-adjusted outcome rate) compared with Caucasian patients.We developed a risk-adjusted, 90-day postoperative outcome measure to identify high-, intermediate-, and low-quality hospitals based on patient records in the Medicare Provider Analysis and Review files between July 1, 2002, and June 30, 2005 (the first cohort). We then analyzed a second cohort of African American and Caucasian patients receiving Medicare who underwent primary TKAs between July and December 2005 to determine the independent impact of race on admissions to high-, intermediate-, and low-quality hospitals.The risk-adjusted postoperative mortality/complication rate varied substantially across hospitals; hospitals can be meaningfully categorized into quality groups. In the second cohort of admissions, 8% of African American patients (n = 4894) versus 9.2% of Caucasian patients (n = 86,705) were treated in high-quality hospitals whereas 14.7% of African American patients versus 12.7% of Caucasians patients were treated in low-quality hospitals. After controlling for patient demographic, socioeconomic, geographic, and diagnostic characteristics, the odds ratio for admission to low-quality hospitals was 1.28 for African American patients compared with Caucasian patients (95% CI, 1.18-1.41).Among elderly Medicare beneficiaries undergoing TKA, African American patients were more likely than Caucasian patients to be admitted to hospitals with higher risk-adjusted postoperative rates of complications or mortality. Future work is needed to address the residential, social, and referring factors that underlie this disparity and implications for outcomes of care.