Regulatory Reforn and Angiography Disparties

描述（由申请人提供）：从1996年开始，新泽西州开始进行医院监管改革，除其他目标外，还解决了心脏血管造影（CA）使用中存在的种族和民族差异的长期问题。这些改革使开展辅助医疗服务的医院数量增加了一倍，并使国家监测到每家医院的少数民族外展和辅助医疗服务获得活动。这项建议建立在由人权理事会资助的试点研究的基础上，以审查这一创新政策的有效性。具体目标是：(1)确定在实施旨在扩大少数民族患者准入的新泽西州政策后，黑人和白人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。西班牙裔和白人的CA差异也将被调查。定量建模和定性分析将混合评估1993-2003年的CA差异趋势，并与非改革状态的趋势进行对比。主要结果测量是小区域年龄性别调整CA率的白人-黑人差异，以及在整个研究期间提供CA的新泽西州医院黑人患者CA使用率的数量和份额。回归方法将用于调整市场区域人口统计和其他因素。关于CA容量变化和医院竞争影响的假设将被检验。根据回归模型，对黑人患者表现出高于预期服务水平的CA设施将与一组表现不佳的匹配比较设施一起被选中进行深入的案例研究。案例研究将侧重于选定设施的市场领域，并将包括文件审查和对选定CA设施、转诊医院、社区保健中心和案例市场中其他参与者的官员进行半结构化访谈。研究结果将以“最佳做法”的形式，并通过对医院特定CA差异绩效指标的反馈，转化为实践和政策界。

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.