RACIAL AND INSURANCE STATUS DISPARITIES IN PATIENT SAFETY INDICATORS AMONG HOSPITALIZED PATIENTS
RACIAL AND INSURANCE STATUS DISPARITIES IN PATIENT SAFETY INDICATORS AMONG HOSPITALIZED PATIENTS
复制标题
DOI：
10.18865/ed.26.3.443
复制
发表时间：
2016-06-01
影响因子：
3.2
通讯作者：
Neishi, Scott
中科院分区：
文献类型：
--
作者：
Shen, Jay J.;Cochran, Christopher R.;Neishi, Scott
目的：探讨住院患者的人种/民族、保险状况及其与患者安全指标的交互作用。数据摘自2009年全国住院患者样本。共有3,052,268名患者安全指标相关的出院被确定。因变量为11个患者安全指标(PSI)，自变量包括种族/民族和保险状况。结果：与白人患者相比，非裔美国人患者更容易发生压疮、术后出血或血肿、术后肺栓塞(PE)或深静脉血栓(DVE)；亚洲/太平洋岛民患者更容易发生压疮、术后PE或DVT以及两个产科护理PSI；而西班牙裔/拉丁裔患者更有可能经历术后生理代谢紊乱和意外穿孔/撕裂。与私人保险患者相比，医疗补助患者更容易发生压疮、术后生理代谢紊乱、术后PE或DVT、术后呼吸衰竭、术后伤口裂开和手术死亡。然而，两种产科护理PSI都显示，与各自的同行相比，非裔美国人、西班牙裔和未参保的患者发生产科疾病的可能性较小。此外，非裔美国人和医疗补助对PSI的交互作用也很强。结论：尽管在我们的研究中观察到了PSI差异的混合结果，但亚洲/太平洋岛民和医疗补助患者似乎是最脆弱的。此外，非裔美国人和医疗补助之间的互动效应表明，贫困可能是造成医疗保健不平等的一个关键因素。未来的研究值得确定与亚洲/太平洋岛民患者的PSI相关的潜在因素。需要制定战略来改善医疗补助患者的PSI，特别是在目前由于《平价医疗法案》的实施而扩大的医疗补助计划期间。
Objective: To examine the association between patient race/ethnicity, insurance status, and their interaction with patient safety indicators among hospitalized patients.Methods: Cross-sectional study was conducted. Data were extracted from the 2009 National Inpatient Sample. A total of 3,052,268 patient safety indicator-related discharges were identified. Dependent variables were 11 patient safety indicators (PSI) whereas independent variables included race/ethnicity and insurance status.Results: As compared with White patients, African American patients were more likely to experience pressure ulcer, postoperative hemorrhage or hematoma, and post-operative pulmonary embolism (PE) or deep vein thrombosis (DVE); Asian/Pacific Islander patients were more likely to experience pressure ulcer, post-operative PE or DVT, and two obstetric care PSIs; whereas Hispanic/Latino patients were more likely to experience post-operative physiometabolic derangement and accidental puncture/laceration. As compared with patients with private insurance, Medicaid patients were more likely to experience pressure ulcer, post-operative physiological metabolic derangement, post-operative PE or DVT, post-operative respiratory failure, post-operative wound dehiscence, and death among surgeries. However, both obstetric care PSIs showed that African Americans, Hispanics, and uninsured patients were less likely to incur them in comparison with their respective counterparts. Furthermore, strong interactive effects between African American and Medicaid on PSIs were detected.Conclusions: Although mixed findings in disparities in PSIs were observed in our study, Asian/Pacific Islander patients and Medicaid patients seem to be the most vulnerable. Further, interactive effects between African American and Medicaid indicate that poverty may be a key factor related to disparities in health care. Future research is merited to identify underlying factors that are related to PSIs among Asian/Pacific Islander patients. Strategies are needed to improve PSIs among Medicaid patients, especially during the current Medicaid program expansion due to the implementation of the Affordable Care Act.