Process of care in Hispanic, black, and white VA beneficiaries
Process of care in Hispanic, black, and white VA beneficiaries
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DOI：
10.1097/00005650-200209000-00011
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发表时间：
2002-09-01
期刊：
影响因子：
3
通讯作者：
Ashton, CM
中科院分区：
文献类型：
--
作者：
Gordon, HS;Johnson, ML;Ashton, CM
目标。目的：探讨西班牙裔、黑人和白人退伍军人福利受益人的医院护理过程是否存在差异。在一项病例对照研究中，2,852名西班牙裔、黑人和白人男性退伍军人管理局受益人从南方12家退伍军人医院之一活着出院，诊断为糖尿病（DM）、充血性心力衰竭（CHF）或慢性阻塞性肺疾病（COPD）。我们将医院护理过程的诊断特异性明确标准应用于每位患者的医院记录，并计算依从性评分；在住院期间执行适用标准的百分比。我们比较了西班牙裔、黑人和白人患者的平均得分，然后用多元线性回归比较了调整后的得分。主要结果测量。西班牙裔、黑人和白人患者入院、治疗和出院时的住院护理过程（依从性评分）。西班牙裔患者、黑人患者和白人CHF和COPD患者的平均入院依从性评分存在差异（P = 0.003），但糖尿病患者没有差异。西班牙裔患者、黑人患者和白人患者的平均治疗和出院评分没有差异。在双变量比较中，黑人患者的平均入院评分高于白人患者的CHF （P = 0.003）和COPD （P = 0.01）。在分层分析中，与非教学医院相比，教学医院的患者入院和治疗评分更高（P = 0.0001）。在调整了进入教学医院和其他协变量后，西班牙裔、黑人和白人患者的住院治疗过程没有差异。与其他研究结果相比，西班牙裔患者、黑人患者和白人患者的住院治疗过程大致相似。我们的研究结果可能反映了退伍军人医院的几个特点，这些特点可能会导致更公平的护理。
OBJECTIVE. To examine whether process of hospital care differs among Hispanic, black, and white VA beneficiaries.SUBJECTS. Two thousand eight-hundred fifty-two Hispanic, black, and white male VA beneficiaries from a case-control study discharged alive from one of twelve southern veterans hospitals with one of three diagnoses, diabetes mellitus (DM), congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD).METHODS. We applied diagnosis-specific explicit criteria for the process of hospital care to each patient's hospital record and computed the adherence score; the percentage of applicable criteria performed during the hospital stay. We compared mean scores in Hispanic, black, and white patients and then compared adjusted scores using multiple linear regression.MAIN OUTCOME MEASURE. Process of inpatient care (adherence score) in Hispanic, black, and white patients at admission, treatment, and discharge.RESULTS. Mean admission adherence scores differed (P = 0.003) among Hispanic patients, black patients, and white patients for CHF and COPD, but not DM. Mean treatment and discharge scores were not different among Hispanic patients, black patients, and white patients. In bivariate comparisons, mean admission scores were higher in black patients compared with white patients for CHF (P = 0.003) and COPD (P = 0.01). In stratified analyses, admission and treatment scores were higher (P = 0.0001) in patients admitted to teaching compared with nonteaching hospitals. Process of inpatient care did not differ among Hispanic, black, and white patients after adjusting for admission to a teaching hospital and other covariates.CONCLUSION. In contrast to findings in other studies, process of inpatient care was generally similar in Hispanic patients, black patients, and white patients. Our findings may reflect several characteristics of veterans' hospitals that may lead to care that is more equitable.