Health care for black and poor hospitalized Medicare patients.
Health care for black and poor hospitalized Medicare patients.
复制标题
黑人和贫困住院医疗保险患者的医疗保健。
DOI：
10.1001/jama.1994.03510390039027
复制
发表时间：
1994
期刊：
影响因子：
--
通讯作者：
E. Keeler
中科院分区：
文献类型：
--
作者：
K. Kahn;M. Pearson;E. R. Harrison;Katherine A. Desmond;W. Rogers;Lisa V. Rubenstein;R. Brook;E. Keeler
目的
分析黑人或来自贫困社区的老年患者是否比其他患者接受更差的医院护理，考虑到医院的影响，并使用有效的护理质量指标。
设计
我们比较提供给投保，住院医疗保险的病人谁是黑人或生活在贫困社区相比，与其他人的护理质量，使用简单和多变量的临床详细措施的疾病入院，质量和结果的比较。
设置
五个州内30个地区的297家急诊医院。
患者或其他参与者
该样本包括9932例65岁或以上的患者，这些患者在因充血性心力衰竭、急性心肌梗死、肺炎或中风住院前住在家中。
干预措施
这是一项观察性研究。
主要观察指标
护理过程、住院时间、出院时的不稳定性、出院目的地和死亡率。
结果
在农村、城市非教学医院和城市教学医院中，黑人或来自贫困社区的患者比其他患者的护理过程更差，出院时更不稳定（P <0.05）。然而，黑人或来自贫困社区的患者在城市教学医院接受护理的可能性高出1.8倍，而城市教学医院已被证明提供更好的护理质量（P < .001），抵消了这种较差的质量。由于这些患者在质量更好的医院接受更多的护理，因此种族和贫困状况在质量上没有总体差异。死亡率不因种族或贫困状况而异。
结论
受保医疗保险患者的医院护理质量受患者的种族和财务特征以及患者接受护理的医院类型的影响。
OBJECTIVE
To analyze whether elderly patients who are black or from poor neighborhoods receive worse hospital care than other patients, taking account of hospital effects and using validated measures of quality of care.
DESIGN
We compare quality of care provided to insured, hospitalized Medicare patients who are black or live in poor neighborhoods as compared with others, using simple and multivariable comparisons of clinically detailed measures of sickness at admission, quality, and outcomes.
SETTING
Two hundred ninety-seven acute care hospitals in 30 areas within five states.
PATIENTS OR OTHER PARTICIPANTS
The sample includes a nationally representative sample of 9932 patients 65 years of age or older who lived at home prior to hospitalization for congestive heart failure, acute myocardial infarction, pneumonia, or stroke.
INTERVENTIONS
This was an observational study.
MAIN OUTCOME MEASURES
Processes of care, length of stay, instability at discharge, discharge destination, and mortality.
RESULTS
Within rural, urban nonteaching, and urban teaching hospitals, patients who are black or from poor neighborhoods have worse processes of care and greater instability at discharge than other patients (P < .05). However, this worse quality is offset by patients who are black or from poor neighborhoods being 1.8 times more likely to receive care in urban teaching hospitals that have been shown to provide better quality of care (P < .001). Because these patients receive more of their care in better-quality hospitals, there are no overall differences in quality by race and poverty status. Death rates did not vary by race or poverty status.
CONCLUSIONS
Quality of hospital care for insured Medicare patients in influenced both by the patient's race and financial characteristics and by the hospital type in which the patient receives care.
黑人和白人之间的健康差异：死亡率和发病率的最新趋势。
DOI：
--
发表时间：
1987
期刊：
The Milbank quarterly
影响因子：
--
作者：
Manton,KG;Patrick,CH;Johnson,KW
通讯作者：
Johnson,KW
老年城市居民与种族相关的差异：一项队列研究，1975-1984。
DOI：
10.1093/geronj/45.4.s163
发表时间：
1990
期刊：
Journal of gerontology
影响因子：
--
作者：
Ford,AB;Haug,MR;Jones,PK;Roy,AW;Folmar,SJ
通讯作者：
Folmar,SJ
黑人/白人死亡率交叉：基于社区的研究调查。
DOI：
10.1093/geronj/40.1.78
发表时间：
1985
期刊：
Journal of gerontology
影响因子：
--
作者：
Wing,S;Manton,KG;Stallard,E;Hames,CG;Tryoler,HA
通讯作者：
Tryoler,HA