Health disparities and stroke: the influence of insurance status on the prevalence of patient safety indicators and hospital-acquired conditions
Health disparities and stroke: the influence of insurance status on the prevalence of patient safety indicators and hospital-acquired conditions
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DOI：
10.3171/2014.12.jns14646
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发表时间：
2015-04-01
影响因子：
4.1
通讯作者：
Rahman, Maryam
中科院分区：
文献类型：
--
作者：
Fargen, Kyle M.;Neal, Dan;Rahman, Maryam
目的：医疗保健研究和质量机构的患者安全指标（psi）和医疗保险和医疗补助服务中心的医院获得性疾病（HACs）是与报销直接相关的公开报告质量指标。psi和HACs的发生与卒中后死亡率和住院费用的增加有关。使用全国住院患者样本（NIS）数据库确定急性缺血性脑卒中住院患者保险状况与PSI和HAC率之间的关系。方法。对2002年至2011年期间涉及急性缺血性中风的所有住院情况进行了NIS查询。通过检索医院记录中的ICD-9编码来确定每次PSI和HAC的发生率。使用SAS统计软件包计算发生率并进行多变量分析，以确定患者变量对每个指标出现概率的影响。结果NIS查询显示了1,507,336个单独的患者入院，其中包含主要付款人和医院教学状况的信息。共有227,676名psi（占入院人数的15.1%）和42,841名HACs（占2.8%）。患者安全指标在医疗补助/自费/免费患者（19.1%）和医疗保险患者（15.0%）中出现的频率高于私人保险患者（13.6%,p < 0.0001）。在多变量分析中，医疗补助、自费或免费患者的住院时间明显更长；与私人保险患者相比，死亡率更高，预后更差（p < 0.0001）。结论：保险状况是卒中后患者安全事件的独立预测因子。私人保险与较低的死亡率、较短的住院时间和改善的临床结果有关。
OBJECT The Agency for Healthcare Research and Quality patient safety indicators (PSIs) and the Centers forMedicare and Medicaid ServiCes hospital-acquired conditions (HACs) are publicly reported quality metrics linked directly to reimbursement. The occurrence of PSIs and HACs is associated with increased mortality and hospital costs after stroke. The relationship between insurance status and PSI and HAC rates in hospitalized patients treated for acute ischemic stroke was determined using the Nationwide Inpatient Sample (NIS) database.METHODS The.NIS was queried for all hospitalizations involving acute ischemic stroke between 2002 and 2011. The rate of each PSI and HAC was determined by searching the hospital records for ICD-9 codes. The SAS statistical software package was used to calculate rates and perform multivariable -analyses to determine the effects of patient variables on the probability of developing each indicator.RESULTS The NIS query revealed 1,507,336 separate patient admissions that had information on both primary payer and hospital teaching status. There were 227,676 PSIs (15.1% of admissions) and 42,841 HACs reported (2.8%). Patient safety indicators occurred more frequently in Medicaid/self-pay/no-charge patients (19.1%) and Medicare patients (15.0%) than in those with private insurance (13.6%; p < 0.0001). In a multivariable analysis, Medicaid, self-pay, or nocharge patients had significantly longer hospital stays; higher mortality, and worse outcomes than those with private insurance (p < 0.0001).CONCLUSIONS Insurance status is an iridependent predictor of patient safety events after stroke. Private insurance is associated with lower mortality, shorter lengths of stay, and improved clinical outcomes.