Insurance Status and Hospital Care for Myocardial Infarction, Stroke, and Pneumonia
Insurance Status and Hospital Care for Myocardial Infarction, Stroke, and Pneumonia
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DOI：
10.1002/jhm.687
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发表时间：
2010-10-01
影响因子：
2.6
通讯作者：
Hicks, LeRoi S.
中科院分区：
文献类型：
--
作者：
Hasan, Omar;Orav, E. John;Hicks, LeRoi S.
背景技术背景：尽管广泛记录的变化，在医疗保健结果的保险状态，很少有全国代表性的研究已经审查了这种差异，在住院setting.Objective：以确定是否有保险相关的差异，在医院护理的3个常见的医疗条件。154，381例成人出院回顾性数据库分析（年龄18-64岁），主要诊断为急性心肌梗死（AMI）、中风或肺炎，来自2005年全国住院患者样本（NIS）。对于每种诊断，我们比较了医疗补助和未保险患者与私人保险患者的住院死亡率、住院时间（LOS）和每次住院费用。与私人保险相比，AMI和中风患者的住院死亡率明显高于未投保者（AMI和卒中的校正比值比[OR]分别为1.52和1.49 [1.29-1.72]，95%置信区间[CI]分别为1.24-1.85和1.29-1.72），肺炎患者中，医疗补助接受者的风险显著更高（1.21 [1.01-1.45]）。排除在住院期间死亡的患者，对于所有3种情况，医疗补助接受者的LOS始终较长（校正比值1.07，AMI的95% CI [1.05-1.09]，卒中为1.17 [1.14-1.20]，肺炎为1.04 [1.03-1.06]），尽管医疗补助接受者的费用在3种情况中只有2种情况下明显更高，（调整后比率1.06，卒中的95% CI [1.04-1.09]，肺炎的95% CI [1.04-1.07]）。在这项对因3种常见疾病住院的工作年龄美国人的全国代表性研究中，与未保险或医疗补助接受者相比，私人保险患者的住院死亡率显着降低。应调查干预措施，以减少住院护理质量与保险有关的差距。医院医学杂志2010;5：452-459。(C)2010年医院医学会。
BACKGROUND: Despite widely documented variations in health care outcomes by insurance status, few nationally representative studies have examined such disparities in the inpatient setting.OBJECTIVE: To determine whether there are insurance-related differences in hospital care for 3 common medical conditions.DESIGN AND SUBJECTS: Retrospective database analysis of 154,381 adult discharges (age 18-64 years) with a principal diagnosis of acute myocardial infarction (AMI), stroke, or pneumonia from the 2005 Nationwide Inpatient Sample (NIS).MEASUREMENTS: For each diagnosis, we compared in-hospital mortality, length of stay (LOS), and cost per hospitalization for Medicaid and uninsured patients with the privately insured.RESULTS: Compared with the privately insured, in-hospital mortality among AMI and stroke patients was significantly higher for the uninsured (adjusted odds ratio [OR] 1.52, 95% confidence interval [CI] [1.24-1.85] for AMI and 1.49 [1.29-1.72] for stroke) and among pneumonia patients was significantly higher for Medicaid recipients (1.21 [1.01-1.45]). Excluding patients who died during hospitalization, LOS was consistently longer for Medicaid recipients for all 3 conditions (adjusted ratio 1.07, 95% CI [1.05-1.09] for AMI, 1.17 [1.14-1.20] for stroke, and 1.04 [1.03-1.06] for pneumonia), although costs were significantly higher for Medicaid recipients for only 2 of the 3 conditions (adjusted ratio 1.06, 95% CI [1.04-1.09] for stroke and 1.05 [1.04-1.07] for pneumonia).CONCLUSIONS: In this nationally representative study of working-age Americans hospitalized for 3 common medical conditions, significantly lower in-hospital mortality was noted for privately insured patients compared with the uninsured or Medicaid recipients. Interventions to reduce insurance-related gaps in inpatient quality of care should be investigated. Journal of Hospital Medicine 2010;5:452-459. (C) 2010 Society of Hospital Medicine.