Temporal Trends in Critical Care Outcomes in US Minority-Serving Hospitals
Temporal Trends in Critical Care Outcomes in US Minority-Serving Hospitals
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DOI：
10.1164/rccm.201903-0623oc
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发表时间：
2020-03-15
影响因子：
24.7
通讯作者：
Badawi, Omar
中科院分区：
文献类型：
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作者：
Danziger, John;de la Hoz, Miguel Angel Armengol;Badawi, Omar
理由：过去10年重症监护的改善是否扩展到所有医院尚未被描述。目的：通过对危重病人的初始队列研究，研究少数民族医院和非少数民族医院重症监护结果的时间趋势。测量和主要结果：使用飞利浦医疗电子ICU研究所数据库，我们确定了少数民族服务医院，即非裔美国人或西班牙裔ICU人口普查超过其区域平均值两倍的医院。我们检查了2006年至2016年期间美国各地208个icu中近110万例危重病入院。调整后的住院死亡率（主要）和住院时间（次要）是主要结局。大多数非裔美国人（25%,n = 27,242）和西班牙裔美国人（48%,n = 26,743）在少数族裔服务的医院接受治疗，而白人只有5.2% （n = 42,941）。在过去的10年里，虽然在非少数民族服务医院，危重疾病死亡率的风险每年稳步下降2%(95%可信区间[CI]， 0.97-0.98)，但少数民族服务医院的结局并没有得到比较大的改善。这种时间趋势的差异在非裔美国人中尤为明显，每增加一个日历年，非少数民族医院的调整后危重疾病死亡率降低3% (95% CI, 0.96-0.97)，但在少数民族医院中没有变化（风险比，0.99;95% CI, 0.97-1.01）。同样，尽管非少数族裔服务医院的ICU和住院时间每增加一个日历年分别减少0.08 （95% CI, -0.08至-0.07）和0.16 （95% CI, -0.16至-0.15）天，但在少数族裔服务医院的非裔美国人的时间变化很小。结论：危重的非洲裔美国人在少数族裔服务的医院中受到的照顾不成比例，在过去10年里，这些医院的改善程度明显低于非少数族裔服务的医院。
Rationale: Whether critical care improvements over the last 10 years extend to all hospitals has not been described.Objectives: To examine the temporal trends of critical care outcomes in minority and non-minority-serving hospitals using an inception cohort of critically ill patients.Measurements and Main Results: Using the Philips Health Care electronic ICU Research Institute Database, we identified minority-serving hospitals as those with an African American or Hispanic ICU census more than twice its regional mean. We examined almost 1.1 million critical illness admissions among 208 ICUs from across the United States admitted between 2006 and 2016. Adjusted hospital mortality (primary) and length of hospitalization (secondary) were the main outcomes. Large pluralities of African American (25%, n = 27,242) and Hispanic individuals (48%, n = 26,743) were cared for in minority-serving hospitals, compared with only 5.2% (n = 42,941) of white individuals. Over the last 10 years, although the risk of critical illness mortality steadily decreased by 2% per year (95% confidence interval [CI], 0.97-0.98) in non-minority-serving hospitals, outcomes within minority-serving hospitals did not improve comparably. This disparity in temporal trends was particularly noticeable among African American individuals, where each additional calendar year was associated with a 3% (95% CI, 0.96-0.97) lower adjusted critical illness mortality within a non-minorityserving hospital, but no change within minority-serving hospitals (hazard ratio, 0.99; 95% CI, 0.97-1.01). Similarly, although ICU and hospital lengths of stay decreased by 0.08 (95% CI, -0.08 to -0.07) and 0.16 (95% CI, -0.16 to -0.15) days per additional calendar year, respectively, in non-minority-serving hospitals, there was little temporal change for African American individuals in minority-serving hospitals.Conclusions: Critically ill African American individuals are disproportionately cared for in minority-serving hospitals, which have shown significantly less improvement than non-minority-serving hospitals over the last 10 years.