Capacity Strain and Racial Disparities in Hospital Mortality
Capacity Strain and Racial Disparities in Hospital Mortality
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医院死亡率的能力紧张和种族差异
DOI：
10.3386/w30380
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Atheendar S. Venkataramani
中科院分区：
文献类型：
--
作者：
Manasvini Singh;Atheendar S. Venkataramani
越来越多的文献记录了健康结果中的种族差异。我们认为，当医院满负荷运转时，当与患者预后不良相关的行为和结构条件（例如，有限的提供者认知带宽或依赖于预先偏向的护理算法）。使用来自两家大医院的详细的、带时间戳的电子健康记录数据，我们记录了当医院满负荷运转时，黑人患者的死亡率比白色患者的死亡率相对增加20%，这完全是由患有更多医疗合并症的患者驱动的。换句话说，如果黑人患者经历了与白色患者相同的容量-死亡率关系，我们样本中8.5%的黑人患者死亡是可以避免的。就潜在机制而言，黑人患者经历了更长的等待时间，ICU入院的可能性较低，住院时间和费用较短，尽管这在所有容量压力水平下都是如此。动态分解分析表明，这些发现最有可能是由额外的偏见，在供应商的行为，医院的流程，和/或护理资源的分配，出现或恶化的压力增加，然后与已经较低的护理强度相互作用，产生差异的死亡率风险。
A growing literature has documented racial disparities in health outcomes. We argue that racial disparities may be magnified when hospitals operate at capacity, when behavioral and structural conditions associated with poor patient outcomes (e.g., limited provider cognitive bandwidth or reliance on ex ante biased care algorithms) are aggravated. Using detailed, time-stamped electronic health record data from two major hospitals, we document a 20% relative increase in mortality for Black compared to White patients when hospitals operate at capacity, driven entirely by patients with more medical comorbidities. Put differently, 8.5% of Black patient deaths in our sample could have been avoided if Black patients had experienced the same capacity-mortality relationship as White patients. In terms of potential mechanisms, Black patients experienced longer wait times, lower likelihoods of ICU admissions, and had shorter lengths of stay and charges, though this was true at all levels of capacity strain. Dynamic decomposition analyses suggest that these findings are most likely driven by additional biases in provider behavior, hospital processes, and/or allocation of care resources that emerge or worsen as strain increases, which then interact with already lower intensities of care to produce differential mortality risks.
影响因子：
120.7
作者：
Joynt, Karen E.;Orav, E. John;Jha, Ashish K.
通讯作者：
Jha, Ashish K.