Regulatory Reforn and Angiography Disparties

描述（由申请人提供）：从1996年开始，新泽西开始进行医院监管改革，除其他目标外，还解决了长期存在的心脏血管造影（CA）使用中的种族和民族差异问题。这些改革使开展保护性儿童服务的医院数量增加了一倍，并使国家对每家医院保护性儿童服务的少数民族外联和获取活动进行了监测。这项建议是在澳大利亚人权事务委员会资助的试点研究的基础上提出的，以审查这一创新政策的有效性。具体目标是：（1）确定在新泽西州实施旨在扩大少数民族患者获得机会的政策后，黑人和白色CA利用率之间的差异是否下降，（2）评估当地卫生系统特征如何影响CA差异以及新泽西州政策可能减少这些差异的途径;（3）确定减少CA差异的有希望的策略。西班牙裔白人CA差异也将进行调查。定量建模和定性分析将混合评估CA差距的趋势，从1993年至2003年相比，在非改革状态的趋势。主要结果指标是在小区域内经年龄-性别调整的CA率的白人-黑人差异，以及在整个研究期间提供CA的NJ医院中黑人患者使用CA的数量和份额。回归方法将用于调整市场区域人口统计和其他因素。CA能力和医院竞争的变化的影响的假设将进行测试。CA设施，证明高于预期水平的服务，以黑人患者，回归模型的基础上，将被选为密集的案例研究沿着与一组匹配的比较设施，是不是高性能。案例研究将侧重于选定机构的市场领域，并将包括对选定CA机构、转诊医院、社区卫生中心和案例市场中其他参与者的官员进行文件审查和半结构化访谈。研究结果将转化为实践和政策界的“最佳实践”的形式，并通过医院的具体CA差距的性能指标的反馈。

DESCRIPTION (provided by applicant): Beginning in 1996, New Jersey embarked on hospital regulatory reforms that addressed, among other goals, the long-standing problem of racial and ethnic disparities in use of cardiac angiography (CA). These reforms led to a doubling in the number of hospitals performing CA as well as state-monitoring of minority outreach and access activities for CA services at each hospital. This proposal builds on AHRQ-funded pilot studies to examine the effectiveness of this innovative policy. Specific aims are to: (1) determine whether the disparity between black and white CA utilization declined following implementation of NJ policies intended to expand access for minority patients, (2) evaluate how local health system characteristics may influence CA disparities and the pathways through which the NJ policy may have reduced these disparities; and (3) identify promising strategies for reducing CA disparities. Hispanic-white CA disparities will also be investigated. Quantitative modeling and qualitative analyses will be blended to evaluate CA disparity trends from 1993-2003 in contrast to trends in a non-reform state. Primary outcome measures are the white-black difference in age-sex adjusted CA rates in small areas and the volume and share of CA utilization by black patients at NJ hospitals that provided CA throughout the study period. Regression methods will be used to adjust for market area demographics and other factors. Hypotheses about the effects of changes in CA capacity and hospital competition will be tested. CA facilities that demonstrate higher-than-expected levels of service to black patients, based on regression models, will be selected for intensive case studies along with a set of matched comparison facilities that are not high performing. The case studies will be focused on the market areas of the selected facilities, and will include documentary review and semi-structured interviews of officials from the selected CA facilities, referring hospitals, community health centers and other players in the case markets. Research findings will be translated to the practice and policy community in the form of "best practices" and through feedback of hospital-specific CA disparity performance measures.