Patient Characteristics Associated With Admission to Low-Safety Inpatient Psychiatric Facilities: Evidence for Racial Inequities.
Patient Characteristics Associated With Admission to Low-Safety Inpatient Psychiatric Facilities: Evidence for Racial Inequities.
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DOI：
10.1176/appi.ps.202000657
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发表时间：
2021-10-01
影响因子：
3.8
通讯作者：
Shields, Morgan C.
中科院分区：
文献类型：
--
作者：
Shields, Morgan C.
作者调查了与低安全性住院精神病院相关的患者人口统计、临床、费用和地理因素。马萨诸塞州2017年All-Payer出院数据(N=39,128名精神病患者)与设施级别的安全指标(N=38个设施)挂钩。通过平均标准化的约束和隔离措施以及每1,000个出院的总体、确凿和与虐待(即言语、身体或性)有关的投诉的5年平均值(α=0.73)，创建了一个安全综合指数。这一组合为五分之一集团提供了安全性能方面的信息。一系列多项回归模型被拟合，其中分别添加了支付和地理位置。与低安全设施的入院独立相关的显著因素是，与白人患者相比，属于种族或少数民族患者(对于非西班牙裔黑人，相对风险比[RRR]=1.71，p<；0.01；对于非西班牙裔亚裔，RRR=5.60，p<；0.01；对于非西班牙裔“其他”种族，RRR=2.17，p<；0.01；对于西班牙裔拉丁裔，RRR=1.29，p<；0.01)，以及没有私人保险(对于自费或未参保，RRR=2.40，p<；0.01)；医疗补助的RRR=1.80，p<；0.01；医疗保险的RRR=1.31，p<；0.01)。据作者所知，这是第一项考察低安全性住院精神病机构入院差异的研究。即使在考虑了结构性种族主义的潜在临床、地理和保险调解人之后，在低安全性住院精神病机构的入院治疗中也发现了明显的种族和民族不平等。除了解决安全绩效问题外，政策制定者还应投资于更好地了解基于社区的转诊、交通方式(例如警察或自己)以及有意或无意的指导和选择的差异如何影响入学和结果。
The author examined patient demographic, clinical, payment, and geographic factors associated with admission to low-safety inpatient psychiatric facilities. Massachusetts all-payer 2017 discharge data (N=39,128 psychiatric patients) were linked to facility-level indicators of safety (N=38 facilities). A composite of safety was created by averaging standardized measures of restraint and seclusion as well as 5-year averages of overall, substantiated, and abuse-related (i.e., verbal, physical, or sexual) complaints per 1,000 discharges (α=0.73). This composite informed quintile groups of safety performance. A series of multinomial regression models were fit, with payment and geography added separately. Notable factors independently associated with admission to low-safety facilities were belonging to a racial or ethnic minority group compared with being a White patient (for non-Hispanic Black, relative risk ratio [RRR]=1.71, p<0.01; for non-Hispanic Asian, RRR=5.60, p<0.01; for non-Hispanic “other” race, RRR=2.17, p<0.01; and for Hispanic-Latinx, RRR=1.29, p<0.01) and not having private insurance (for self-pay or uninsured, RRR=2.40, p<0.01; for Medicaid, RRR=1.80, p<0.01; and for Medicare, RRR=1.31, p<0.01). To the best of the author’s knowledge, this is the first study to examine differences in admission to low-safety inpatient psychiatric facilities. Even after accounting for potential clinical, geographic, and insurance mediators of structural racism, stark racial and ethnic inequities were found in admission to low-safety inpatient psychiatric facilities. In addition to addressing safety performance, policy makers should invest in gaining a better understanding of how differences in community-based referrals, mode of transport (e.g., police or self), and deliberate or unintentional steering and selection affect admissions and outcomes.
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