Disparities in women's referral to and enrollment in outpatient cardiac rehabilitation
Disparities in women's referral to and enrollment in outpatient cardiac rehabilitation
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DOI：
10.1111/j.1525-1497.2004.30300.x
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发表时间：
2004-07-01
影响因子：
5.7
通讯作者：
Young, DR
中科院分区：
文献类型：
--
作者：
Allen, JK;Scott, LB;Young, DR
目的：本研究的目的是确定有资格参加2期心脏康复项目的非裔美国人和白色妇女的转诊和登记的预测因素，包括种族差异。共有253名女性（108名非洲裔美国人，145名白色）在出院后的第一个月内接受了经皮冠状动脉介入治疗、冠状动脉搭桥手术或心肌梗死（无血运重建）的调查。共有234人（99名非洲裔美国人，135名白色）完成了6个月的随访。主要结果：非洲裔美国妇女转诊到门诊2期心脏康复的比率明显低于白色妇女，12人（12%）比33人（24%）（P= 0.03）。在这项研究中，只有35名（15%）女性报告参加了2期心脏康复计划，与白色女性相比，非洲裔美国女性报告参加的人数较少，9人（9%）对26人（19%）（P= 0.03）。控制年龄、教育、心绞痛等级和合并症，年收入20，000美元的女性（P= .01）。虽然边缘显着，非洲裔美国妇女是55%，（P= 0.059），58%的人不太可能参加（P= .059）。结论：我们发现在心脏康复项目的参与上存在差异，收入较低的妇女不太可能被转诊，心脏康复的登记率较低，非洲人的趋势很强，美国女性被推荐和注册的可能性更小。由于几乎所有发生过急性冠状动脉事件的患者，无论是否进行了血运重建手术，都将从心脏康复中受益，因此应考虑使用自动转诊系统以提高利用率并减少差异。
OBJECTIVE: The purpose of this study was to determine the predictors of referral and enrollment, including racial differences, in phase 2 cardiac rehabilitation programs among African-American and white women who are eligible for such programs.DESIGN: Prospective longitudinal design.SETTING: One large academic medical center and two large community hospitals.PATIENTS: A total of 253 women (108 African American, 145 white) were surveyed within the first month of discharge from the hospital for a percutaneous coronary intervention, coronary artery bypass surgery, or myocardial infarction without revascularization. A total of 234 (99 African American, 135 white) completed the 6-month follow-up.MAIN RESULTS: The rate of referral to outpatient phase 2 cardiac rehabilitation was significantly lower for African-American women compared with white women, 12 (12%) versus 33 (24%) (P= .03). Only 35 (15%) of women in the study reported enrollment in phase 2 cardiac rehabilitation programs, with fewer African-American women reporting enrollment compared with white women, 9 (9%) versus 26 (19%) (P= .03). Controlling for age, education, angina class, and comorbidities, women with annual incomes $20,000 (P= .01). Although borderline significant, African-American women were 55% less likely to be referred (P= .059) and 58% less likely to enroll (P= .059) than white women.CONCLUSIONS: We found disparities in cardiac rehabilitation program participation, with women with lower incomes less likely to be referred and to have lower enrollment rates in cardiac rehabilitation and a strong trend for African-American women to be less likely to be referred and enroll. Because almost all patients who have had an acute coronary event, with or without revascularization procedures, will benefit from cardiac rehabilitation, automatic referral systems should be considered to increase utilization and reduce disparities.