Racial and Ethnic Disparities in Hospital Readmissions After Delivery.
Racial and Ethnic Disparities in Hospital Readmissions After Delivery.
复制标题
产后再入院的种族和民族差异。
DOI：
10.1097/aog.0000000000001360
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发表时间：
2016
影响因子：
7.2
通讯作者：
Rebeiro,PeterF
中科院分区：
文献类型：
--
作者：
Sundermann,AlexandraC;Rebeiro,PeterF
降低再入院率的愿望是由再住院是护理质量差的一个指标这一概念所激发的。机构内的实践（例如，处方药物和患者教育）可能会影响再入院率，与患者特征无关。在“分娩后再入院的种族和民族差异”中列出的分析调整了再入院的多个风险因素，但没有控制医疗机构。1我们建议，准确地描述种族差异的再入院将加强会计的做法和人口之间的差异设施。考虑下面的例子，其中明显的种族-种族差异在医院再次入院剖宫产是由两个再入院的结果和种族组成的医院之间的差异解释（表1）。两个假设的医院有不同的30天再入院率描述的种族。贡献于总优势比（OR）的值与Aseltine等人提出的结果一致，并且医院之间黑人和白色患者的分布反映了康涅狄格州邮政编码之间的真实差异。[2]每家医院的再入院比例与种族无关（A医院：OR 1.00; B医院：OR 0.97），但未校正的总OR（2.05）表明黑人女性的再入院几率是白色女性的两倍。然而，在调整护理部位后，这种关联为零（调整OR 0.99）。因此，一个未经调整的分析的结果，确定种族-民族的差距，而不存在。生殖健康方面的种族-族裔差异对于解决我们保健系统中的不平等问题很重要。然而，为了充分研究这些差异，必须对护理地点进行调整，以防止护理质量的变化不适当地归因于种族或民族。
Desire to mitigate hospital readmission rates is motivated by the concept that rehospitalization is an indication of poor quality of care. Practices within facilities (eg, medications prescribed and patient education) may affect readmission rates independent of patient characteristics. The analysis presented in “Racial and Ethnic Disparities in Hospital Readmissions After Delivery” adjusted for multiple risk factors for readmission but did not control for health care facility. 1 We propose that accurately characterizing racial disparities in readmissions would be enhanced by accounting for practice and population differences between facilities. Consider the following example, in which apparent racial–ethnic disparities in hospital readmission for cesarean birth are explained by differences in both readmission outcomes and racial composition across hospitals (Table 1). Two hypothetical hospitals with different 30-day readmission rates are described by race. Values contributing to the aggregate odds ratio (OR) coincide with findings presented by Aseltine et al, and the distribution of black and white patients between hospitals reflects true variability between Connecticut zip codes. 2 The proportion of readmissions in each hospital is independent of race (hospital A: OR 1.00; hospital B: OR 0.97), yet the unadjusted aggregate OR (2.05) implies that black women have twice the odds of readmission as white women. However, after adjusting for site of care, this association is null (adjusted OR 0.99). Consequently, an unadjusted analysis results in identifying racial–ethnic disparities where none exist. Racial–ethnic disparities in reproductive health are important to characterize to address inequalities in our health care system. However, to adequately study these disparities, site of care must be adjusted for to prevent variability in quality of care being inappropriately attributed to race or ethnicity.