Racial, Ethnic, and Socioeconomic Disparities in Patient Safety Events for Hospitalized Children.
Racial, Ethnic, and Socioeconomic Disparities in Patient Safety Events for Hospitalized Children.
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DOI：
10.1542/hpeds.2018-0131
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发表时间：
2019-01-01
影响因子：
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通讯作者：
Schuster, Mark A
中科院分区：
文献类型：
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作者：
Stockwell, David C;Landrigan, Christopher P;Schuster, Mark A
结论：以前的研究揭示了护理质量和患者安全方面的种族/民族和社会经济差异。然而，这些差异尚未在儿科住院环境中通过使用临床确认的不良事件（AE）进行检查。在这项研究中，我们这样做，使用全球评估儿科患者安全（GAPPS）触发Tool.METHODS：GAPPS被应用于从16家医院出院的儿科患者的医疗记录随机选择的儿科研究住院设置网络在美国4个地区，从2007年1月至2012年12月。根据患者种族/民族确定住院儿童不良事件的差异（黑人、拉丁裔、白色或其他; N = 17336患者日）和保险状态结果：与住院的非拉丁裔白色儿童相比，住院的拉丁裔儿童的所有AE发生率更高（拉丁裔：30.1起AE/1000患者日，而白色：16.9起AE/1000患者日; P ≤ .001），可预防AE（拉丁裔：15.9起AE/1000患者日，而白色：8.9起AE/1000患者日; P = .002）和高严重程度AE（拉丁裔：12.6起AE/1000患者日，而白色：7.7起AE/1000患者日; P = 0.02）。与私人保险的儿童相比，公共保险的儿童发生可预防AE的比例更高（公共保险：12.1起AE/1000患者日，私人保险：8.5起AE/1000患者日; P = 0.02）。其他groups.CONCLUSIONS：GAPPS分析显示，在广泛的地理和医院环境中，住院儿童经历的AE发生率存在种族和/或民族和社会经济差异。进一步的调查可能会揭示这些差异的潜在机制，并有助于医院减少伤害。
OBJECTIVES: Previous studies have revealed racial/ethnic and socioeconomic disparities in quality of care and patient safety. However, these disparities have not been examined in a pediatric inpatient environment by using a measure of clinically confirmed adverse events (AEs). In this study, we do so using the Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool.METHODS: GAPPS was applied to medical records of randomly selected pediatric patients discharged from 16 hospitals in the Pediatric Research in Inpatient Settings Network across 4 US regions from January 2007 to December 2012. Disparities in AEs for hospitalized children were identified on the basis of patient race/ethnicity (black, Latino, white, or other; N = 17336 patient days) and insurance status (public, private, or self-pay/no insurance; N = 19030 patient days).RESULTS: Compared with hospitalized non-Latino white children, hospitalized Latino children experienced higher rates of all AEs (Latino: 30.1 AEs per 1000 patient days versus white: 16.9 AEs per 1000 patient days; P ≤ .001), preventable AEs (Latino: 15.9 AEs per 1000 patient days versus white: 8.9 AEs per 1000 patient days; P = .002), and high-severity AEs (Latino: 12.6 AEs per 1000 patient days versus white: 7.7 AEs per 1000 patient days; P = .02). Compared with privately insured children, publicly insured children experienced higher rates of preventable AEs (public: 12.1 AEs per 1000 patient days versus private: 8.5 AEs per 1000 patient days; P = .02). No significant differences were observed among other groups.CONCLUSIONS: The GAPPS analysis revealed racial and/or ethnic and socioeconomic disparities in rates of AEs experienced by hospitalized children across a broad range of geographic and hospital settings. Further investigation may reveal underlying mechanisms of these disparities and could help hospitals reduce harm.