Quality of care by race and gender for congestive heart failure and pneumonia
Quality of care by race and gender for congestive heart failure and pneumonia
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DOI：
10.1097/00005650-199912000-00009
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发表时间：
1999-12-01
期刊：
影响因子：
3
通讯作者：
Epstein, AM
中科院分区：
文献类型：
--
作者：
Ayanian, JZ;Weissman, JS;Epstein, AM
背景资料。主要手术的比率按种族和性别的差异有很好的描述，但很少有研究评估按种族和性别的基本医院服务的护理质量。目的：按种族和性别评估护理质量。结果：在调整后的分析中，黑人充血性心力衰竭或肺炎患者的总体护理质量低于其他患有这些疾病的患者(P<；0.05)，在显性措施上，总体护理质量没有性别差异。在这两种情况下，女性从医生那里得到的认知护理都比男性差，而护士对肺炎的认知护理更好，对充血性心力衰竭的治疗更好(P<；0.05)。对于充血性心力衰竭而不是肺炎，通过隐性回顾，女性得到的护理质量比男性差(P=0.03)。结论：在两种常见疾病的基本医院服务中，一致的种族护理质量差异持续存在。医生、护士和政策制定者应该努力消除这些差异。护理质量方面的性别差异不那么明显，可能会因条件和提供者或服务的类型而异。
BACKGROUND. Variations in the rates of major procedures by race and gender are well described, but few studies have assessed the quality of care by race and gender for basic hospital services.OBJECTIVE. To assess quality of care by race and gender.RESEARCH DESIGN. Retrospective review of medical records.SUBJECTS. Stratified random sample of 2,175 Medicare beneficiaries hospitalized for congestive heart failure or pneumonia in Illinois, New York, and Pennsylvania during 1991 and 1992.MEASURES. Explicit process criteria and implicit review by physicians.RESULTS. In adjusted analyses, black patients with congestive heart failure or pneumonia received lower quality of care overall than other patients with these conditions by both explicit process criteria and implicit review (P < 0.05), On explicit measures, overall quality of care did not differ by gender for either condition, but significant differences were noted on explicit subscales. Women received worse cognitive care than men from physicians for both conditions, better cognitive care from nurses for pneumonia, and better therapeutic care for congestive heart failure (P < 0.05). Women received worse quality of care than men by implicit, review (P = 0.03) for congestive heart failure but not pneumonia.CONCLUSIONS. Consistent racial differences in quality of care persist in basic hospital services for two common medical conditions. Physicians, nurses, and policy makers should strive to eliminate these differences. Gender differences in quality of care are less pronounced and may vary by condition and type of provider or service.