Black Patients More Likely Than Whites To Undergo Surgery At Low-Quality Hospitals In Segregated Regions
Black Patients More Likely Than Whites To Undergo Surgery At Low-Quality Hospitals In Segregated Regions
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DOI：
10.1377/hlthaff.2011.1365
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发表时间：
2013-06-01
期刊：
影响因子：
9.7
通讯作者：
Birkmeyer, John D.
中科院分区：
文献类型：
--
作者：
Dimick, Justin;Ruhter, Joel;Birkmeyer, John D.
研究表明，黑人病人比白色病人更经常在低质量的医院接受手术。我们评估了居住在种族隔离地区和居住在地理位置接近低质量医院的地区对这种差异的影响程度。使用2005-08年接受三种高风险手术之一的所有患者的国家医疗保险数据，我们发现黑人患者实际上比白色患者更倾向于住在更高质量的医院附近，但在低质量医院接受手术的可能性比白人高25- 58%。种族隔离也是一个因素，在种族隔离最严重的地区，黑人患者在低质量医院接受手术的可能性比白色患者高41%-96%。为了解决这些差异，护理导航员和相对质量的公开报告可以引导患者及其转诊医生前往质量更高的医院，而质量改进工作可以集中在改善那些不成比例地为黑人患者服务的医院的高风险手术的结果。不幸的是，现有的政策，如按业绩付费，捆绑支付，以及不支付不利事件可能会转移资源，加剧这些差距。
Research has shown that black patients more frequently undergo surgery at low-quality hospitals than do white patients. We assessed the extent to which living in racially segregated areas and living in geographic proximity to low-quality hospitals contribute to this disparity. Using national Medicare data for all patients who underwent one of three high-risk surgical procedures in 2005-08, we found that black patients actually tended to live closer to higher-quality hospitals than white patients did but were 25-58 percent more likely than whites to receive surgery at low-quality hospitals. Racial segregation was also a factor, with black patients in the most segregrated areas 41-96 percent more likely than white patients to undergo surgery at low-quality hospitals. To address these disparities, care navigators and public reporting of comparative quality could steer patients and their referring physicians to higher-quality hospitals, while quality improvement efforts could focus on improving outcomes for high-risk surgery at hospitals that disproportionately serve black patients. Unfortunately, existing policies such as pay-for-performance, bundled payments, and nonpayment for adverse events may divert resources and exacerbate these disparities.