Disparities in access to specialty care and emergency department use after hospital discharge to a skilled nursing facility.
Disparities in access to specialty care and emergency department use after hospital discharge to a skilled nursing facility.
复制标题
出院到专业护理机构后获得专业护理和急诊科使用的差异。
DOI：
10.1002/jhm.13006
复制
发表时间：
2023
影响因子：
2.6
通讯作者：
Ryskina,Kira
中科院分区：
文献类型：
--
作者：
Krickus,Casey;Aysola,Jaya;Ryskina,Kira
在熟练护理机构（snf）的患者中获得专家的模式以前没有描述过。目的根据患者特征（包括种族/民族和在SNF住院前接受过专业护理的患者）衡量门诊专科随访和随后的急诊科（ED）就诊情况。设计、设置和参与者本回顾性队列研究使用最小数据集和2012年至2014年SNF入院受益人的100%医疗保险服务费用索赔。外科手术的住院时间不包括在内。主要结局和测量：使用逻辑回归和线性回归测量急诊科就诊、随访和种族/民族之间的关系，并根据患者人口统计学和临床特征进行调整。结果样本包括1,117,632例≥65岁的医疗保险受益人住院，由医疗专科医生咨询，然后出院到SNF。根据医疗保险受益人记录，在样本中，85.4%为非西班牙裔白人（NHW）， 14.6%为黑人、土著和有色人种（BIPOC）。在SNF期间，与NHW患者相比，BIPOC患者获得专科随访的几率较低（优势比[OR]: 0.96, 95%可信区间[CI]: 0.94-0.99,p= 0.004）。与NHW患者相比，BIPOC患者的ED就诊率更高（随访：24.1% vs. 23.4%，未随访：27.4% vs. 25.9%,p< 0.001）。缺乏随访与BIPOC和NHW患者ED就诊差异0.8个百分点相关（95% CI: 0.3-1.3,p= 0.003）。结论：BIPOC患者出院后对SNF的亚专科随访存在种族/民族差异，这与BIPOC患者后续ED就诊率较高有关。
BackgroundPatterns in access to specialists among patients in skilled nursing facilities (SNFs) have not been previously described.ObjectiveTo measure access to outpatient specialty follow‐up and subsequent emergency department (ED) visits by patient characteristics, including race/ethnicity and those who received specialty care during the hospitalization that preceded the SNF stay.Design, Settings, and ParticipantsThis retrospective cohort study used the minimum data set and 100% Medicare fee‐for‐service claims for beneficiaries admitted to an SNF between 2012 and 2014. Hospital stays for surgical procedures were excluded.Main Outcome and Measures: The associations between ED visits, follow‐up, and race/ethnicity were measured using logistic and linear regression, adjusting for patient demographic and clinical characteristics.ResultsThe sample included 1,117,632 hospitalizations by Medicare beneficiaries ≥65 with a consult by a medical subspecialist followed by discharge to SNF. Of the sample, 85.4% were non‐Hispanic White (NHW) and 14.6% were Black, indigenous, and people of color (BIPOC), according to Medicare beneficiary records. During the SNF stay, BIPOC patients had lower odds of specialty follow‐up compared to NHW patients (odds ratio [OR]: 0.96, 95% confidence intervals [CI]: 0.94–0.99,p= .004). BIPOC patients had higher rates of ED visits compared to NHW patients (with follow‐up: 24.1% vs. 23.4%, and without follow‐up: 27.4% vs. 25.9%,p< .001). Lack of follow‐up was associated with a 0.8 percentage point difference in ED visits between BIPOC and NHW patients (95% CI: 0.3–1.3,p= .003).ConclusionsThere is a racial/ethnic disparity in subspecialty follow‐up after hospital discharge to SNF that is associated with a higher rate of subsequent ED visits by BIPOC patients.