Impact of race on health care utilization and outcomes in veterans with congestive heart failure
Impact of race on health care utilization and outcomes in veterans with congestive heart failure
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DOI：
10.1016/j.jacc.2003.10.033
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发表时间：
2004-03-03
影响因子：
24
通讯作者：
Wray, NP
中科院分区：
文献类型：
--
作者：
Deswal, A;Petersen, NJ;Wray, NP
本研究的目的是确定在一个经济上“平等获得”的医疗保健系统，退伍军人健康管理局（VA），为了解释在黑人中观察到的再入院率增加和死亡率降低的矛盾，CHF住院的患者，据推测，黑人患者可能减少了门诊治疗，导致较少的疾病严重程度的住院人数较高。方法在一项回顾性研究中，4,901名黑人和17,093名白色退伍军人在153家退伍军人医院CHF住院，我们评估了30天和2年的死亡率，结果黑人与白色患者30天和2年死亡率的风险调整优势比（OR）分别为0.70（95%CI 0.60 ~ 0.82）和0.84（95%CI 0.78 ~ 0.91）。在出院后的一年里，黑人的再入院率与白人相同。黑人有较低的医疗门诊就诊率和较高的急诊/急诊室就诊率比whites，虽然这些差异都很小。CONCLUSIONS在一个系统中，有平等获得医疗保健，种族差距的模式，医疗利用率是小的。CHF住院治疗后黑人患者的生存率较好，这一观察结果并不容易用医疗保健利用的差异来解释。(C)2004年，美国心脏病学会基金会。
OBJECTIVES The objectives of this study were to determine racial differences in mortality in a national cohort of patients hospitalized with congestive heart failure (CHF) within a financially "equal-access" healthcare system, the Veterans Health Administration (VA), and to examine racial differences in patterns of healthcare utilization following hospitalization.BACKGROUND To explain the observed paradox of increased readmissions and lower mortality in black patients hospitalized with CHF, it has been postulated that black patients may have reduced access to outpatient care, resulting in a higher number of hospital admissions for lesser disease severity.METHODS In a retrospective study of 4,901 black and 17,093 white veterans hospitalized with CHF in 153 VA hospitals, we evaluated mortality at 30 days and 2 years, and healthcare utilization in the year following discharge.RESULTS The risk-adjusted odds ratios (OR) for 30-day and 2-year mortality in black versus white patients were 0.70 (95% confidence interval [CI] 0.60 to 0.82) and 0.84 (95% CI 0.78 to 0.91), respectively. In the year following discharge, blacks had the same rate of readmissions as whites. Blacks had a lower rate of medical outpatient clinic visits and a higher rate of urgent care/emergency room visits than whites, although these differences were small.CONCLUSIONS In a system where there is equal access to healthcare, the racial gap in patterns of healthcare utilization is small. The observation of better survival in black patients after a CHF hospitalization is not readily explained by diffierences in healthcare utilization. (C) 2004 by the American College of Cardiology Foundation.