Lower use of carotid artery imaging at minority-serving hospitals
Lower use of carotid artery imaging at minority-serving hospitals
复制标题
DOI：
10.1212/wnl.0b013e31825f04c5
复制
发表时间：
2012-07-01
期刊：
影响因子：
9.9
通讯作者：
Bravata, Dawn M.
中科院分区：
文献类型：
--
作者：
Cheng, Eric M.;Keyhani, Salomeh;Bravata, Dawn M.
目的：我们确定是否网站的护理解释了以前确定的种族差异在颈动脉imaging.Methods：在这项回顾性队列研究中，数据来自于一个图表审查127退伍军人管理局医院在2007年因缺血性中风住院的退伍军人。应用广泛的排除标准以获得应接受颈动脉成像的样本。少数民族服务医院被定义为按黑人中风患者比例排名的前10%的医院。人群水平的多变量logistic回归模型，调整相关性的患者在医院被用来计算颈动脉成像的预测概率的种族和少数民族服务的医院状态。结果：样本包括1,534名白色患者和628名黑人患者。近40%的黑人患者被13家少数民族医院中的一家收治。在非少数民族服务的医院中，没有发现接受颈动脉成像的种族差异。然而，在非少数民族医院接受颈动脉成像的白色患者的预测概率（89.7%，95% CI [87.3%，92.1%]）显著高于2例白色患者（78.0% [68.3%，87.8%]和黑人患者（70.5% [59.3%，81.6%]）在少数民族服务的医院。需要进一步的工作，以探讨为什么网站的护理是一种机制，在这个临床上重要的诊断测试种族差异。神经病学（R）2012;79：138-144
Objective: We determined whether site of care explains a previously identified racial disparity in carotid artery imaging.Methods: In this retrospective cohort study, data were obtained from a chart review of veterans hospitalized with ischemic stroke at 127 Veterans Administration hospitals in 2007. Extensive exclusion criteria were applied to obtain a sample who should have received carotid artery imaging. Minority-serving hospitals were defined as the top 10% of hospitals ranked by the proportion of stroke patients who were black. Population level multivariate logistic regression models with adjustment for correlation of patients in hospitals were used to calculate predictive probabilities of carotid artery imaging by race and minority-service hospital status. Bootstrapping was used to obtain 95% confidence intervals (CIs).Results: The sample consisted of 1,534 white patients and 628 black patients. Nearly 40% of all black patients were admitted to 1 of 13 minority-serving hospitals. No racial disparity in receipt of carotid artery imaging was detected within nonminority serving hospitals. However, the predicted probability of receiving carotid artery imaging for white patients at nonminority-serving hospitals (89.7%, 95% CI [87.3%, 92.1%]) was significantly higher than both white patients (78.0% [68.3%, 87.8%] and black patients (70.5% [59.3%, 81.6%]) at minority-serving hospitals.Conclusions: Underuse of carotid artery imaging occurred most often among patients hospitalized at minority-serving hospitals. Further work is required to explore why site of care is a mechanism for racial disparities in this clinically important diagnostic test. Neurology (R) 2012;79:138-144