Concentration and quality of hospitals that care for elderly black patients
Concentration and quality of hospitals that care for elderly black patients
复制标题
DOI：
10.1001/archinte.167.11.1177
复制
发表时间：
2007-06-11
影响因子：
--
通讯作者：
Epstein, Arnold M.
中科院分区：
文献类型：
--
作者：
Jha, Ashish K.;Orav, E. John;Epstein, Arnold M.
背景：医疗保健中种族差异的原因尚不清楚，但人们接受护理的医院的特点可能是影响患者接受护理质量的重要因素。因此，我们试图确定在医院接受治疗的老年黑人与白人患者的比例和数量，并检查收治大量黑人患者的医院的特征和绩效。方法：我们使用 2004 年医疗保险数据来计算研究中每家医院的黑人患者出院数量和比例。然后，我们根据急性心肌梗死、充血性心力衰竭和肺炎患者的质量衡量标准，检查了医院的结构特征和绩效。结果：黑人患者数量最多的 5% 的医院照顾了近一半的老年黑人患者，而患者数量排名前四分之一的医院则照顾了近 90% 的老年黑人患者。与黑人患者数量较少的医院相比，黑人患者数量较多的医院规模更大，并且更多地是位于美国南部的教学医院（每次比较 P < .001）。黑人患者比例较高的医院也具有类似的特征。调整医院特征后，治疗黑人患者数量较多的医院与治疗较少黑人患者的医院在急性心肌梗死（89.0 vs 90.7；P = .002）和肺炎指标（76.9 vs 79.4；P < .001）方面的绩效总结得分较差。对医院转诊地区进行调整消除了急性心肌梗死的表现评分差距，但没有消除肺炎的表现评分差距。治疗黑人患者比例高的医院与治疗黑人患者比例低的医院在绩效评分上存在可比差异。 结论：在美国，黑人患者的医院护理明显集中在一小部分医院，尽管护理比例高的黑人患者的医院的护理质量仅比护理比例低的黑人患者的医院稍差。黑人患者的集中程度为通过针对一小部分医院的努力来改善对黑人患者的护理提供了新的机会。
Background: The reasons for racial differences in health care are not well known, but the characteristics of hospitals where people receive care may be an important factor in the quality of care that patients receive. Therefore, we sought to determine the proportion and volume of elderly black vs white patients treated at hospitals and examine the characteristics and performances of hospitals that care for disproportionately high volumes of black patients.Methods: We used 2004 Medicare data to calculate, for each hospital in our study, the volume and proportion of black patients discharged. We then examined the hospitals' structural characteristics and performances according to quality measures for patients with acute myocardial infarction, congestive heart failure, and pneumonia.Results: The 5% of hospitals with the highest volume of black patients cared for nearly half of all elderly black patients, and the hospitals in the top quartile by volume of patients cared for nearly 90% of elderly black patients. Hospitals with a high volume of black patients were larger and were more often teaching hospitals located in the southern United States ( P < .001 for each comparison) than those with a low volume of black patients. Hospitals with a high proportion of black patients had comparable characteristics. After adjusting for hospital characteristics, hospitals that treated a high vs low volume of black patients had worse performance summary scores for acute myocardial infarction ( 89.0 vs 90.7; P = .002) and pneumonia measures ( 76.9 vs 79.4; P < .001). Adjusting for hospital referral region eliminated the gap in performance scores for acute myocardial infarction but not for pneumonia. There were comparable differences in performance scores for hospitals that treated a high vs low proportion of black patients.Conclusions: Hospital care for black patients in the United States is remarkably concentrated in a small percentage of hospitals, although the hospitals that care for a high proportion of black patients have only marginally worse quality of care than those that care for a low proportion of black patients. The level of concentration of black patients provides a fresh opportunity to improve care for black patients by targeting efforts toward a small group of hospitals.