Quality of hospital care for Maori patients in New Zealand: retrospective cross-sectional assessment
Quality of hospital care for Maori patients in New Zealand: retrospective cross-sectional assessment
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DOI：
10.1016/s0140-6736(06)68847-8
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发表时间：
2006-06-10
期刊：
影响因子：
168.9
通讯作者：
Scott, Alastair
中科院分区：
文献类型：
--
作者：
Davis, Peter;Lay-Yee, Roy;Scott, Alastair
背景新西兰有一个重要的土著少数民族-毛利人-有相当差的健康状况比大多数人口。我们的目的是评估可能存在的差距，毛利人的医院护理质量与可预防的不良事件的数据作为一个指标的次优treatment.Methods我们进行了4个全国代表性的横断面调查，一般公立医院的入院超过100张病床提供急性护理。采用分层系统列表抽样方法，抽取13所医院1998年住院患者6579例。我们采用结构化内隐回顾法对记录进行了两阶段回顾性评估。结果措施的发生，效果和可预防性的不良事件。调查结果毛利人占刚刚超过15%的入院，平均年轻，更有可能是从贫困地区，有不同的情况下组合，并在医院的住院时间较短的非毛利/非太平洋血统的患者相比。总体而言，在年龄标准化后，14%的毛利人入院与不良事件相关，而非毛利人/非太平洋患者为11%（组间差异p=0.01）。对于可预防的住院事件，在控制了年龄、其他社会人口学因素和病例组合后，这种差异仍然存在（调整后的比值比为1.47; p=0.05）。潜在的因果因素的分析表明，没有显着或一贯不同的模式之间的groups.Interpretation尽管主要是公共资助的医院系统，我们的研究结果表明，毛利人接受的医院护理是略差于新西兰公民的非毛利/非太平洋血统。尽管没有明显的毛利人特有的原因，但各种政策和制度问题是可以解决的。
Background New Zealand has a substantial indigenous minority-the Maori-that has considerably worse health status than the majority population. We aimed to assess possible disparities in quality of hospital care for Maori with data on preventable adverse events as an indicator of suboptimum treatment.Methods We undertook 4 nationally representative cross-sectional survey of admissions to general public hospitals with more than 100 beds providing acute care. A sample of 6579 patients admitted in 1998 to 13 hospitals was selected by stratified systematic list sample. We did a two-stage retrospective assessment of records by structured implicit review. Outcome measures were occurrence, effect, and preventability of adverse events.Findings Maori accounted for just greater than 15% of admissions and were on average younger, were more likely to be from from deprived areas, had a different case mix, and were in hospital for a shorter stay compared with patients of non-Maori/non-Pacific origin. Overall, after age standardisation, 14% of admissions for Maori were associated with an adverse event, compared with 11% for non-Maori/non-Pacific patients (p=0.01 for difference between groups). For preventable, in-hospital events, this disparity persisted after controlling for age, other sociodemographic factors, and case mix (adjusted odds ratio 1.47; p=0.05). Analysis of potential causal factors showed no markedly or consistently different pattern between the groups.Interpretation Despite a predominantly publicly funded hospital system, our findings suggest that hospital care received by Maori is marginally poorer than that received by New Zealand citizens of non-Maori/non-Pacific origin. Although no cause specific to Maori was evident, various policy and system issues can be addressed.