National Estimates for Inpatient Care, Outcomes & Hospital Effect among Hispanics

西班牙裔现在是美国最大的少数民族或种族。基于全国调查或死亡记录的证据表明，与非西班牙裔白人或非西班牙裔黑人相比，健康行为和风险存在显著差异。由于较高的保险比率、贫困和卫生知识不足，西班牙裔人在获得医疗保健方面也面临更大的风险。然而，在全国范围内，对西班牙裔患者的住院治疗机会、质量或出院结果知之甚少。这主要是由于在国家住院护理数据来源中对西班牙裔受试者的识别不佳。这种知识上的差距限制了“制定和监测国家目标、制定政策和设计立法以解决差距”的能力。我们建议采用一种新颖的方法，将州住院出院（SID）数据与人口普查数据结合起来，获得西班牙裔成年人住院护理利用的代表性估计，并将其与非西班牙裔白人和非西班牙裔黑人进行对比。我们将研究来自15个州的SID数据（2010-11），这些州占全国西班牙裔成年人口的87%以上。我们将检查一系列不同护理领域的住院护理指标。作为

DESCRIPTION (provided by applicant): Project Summary Hispanics now form the largest ethnic or racial minority in the US. Evidence based on national surveys or death records indicates significant differences in health behaviors and risk compared to non-Hispanic Whites or non-Hispanic Blacks. Hispanics are also at greater risk for healthcare access barriers due to higher rates of insurance, poverty and inadequate health literacy. However, little is known about inpatient care access, quality or discharge outcomes among Hispanics nationally. This is largely due to poor identification of Hispanic subjects in national inpatient care data sources. This gap in knowledge limits the ability "to set and monitor national objectives, to formulate policy, and t design legislation to address the disparities". We propose to use a novel approach of combining state inpatient discharge (SID) data along with census population data to obtain representative estimates of inpatient care utilization for Hispanic adults and contrast them with those for non-Hispanic Whites and non-Hispanic Blacks. We will examine SID data (2010-11) from 15 states that together account for over 87 percent of the national Hispanic adult population. We will examine a range of inpatient care indicators of distinct domains of care. As indicators of access to care, we will use the ACSC conditions identified by Agency for Healthcare Research Quality (AHRQ) Prevention Quality Indicators (PQIs) (e.g., diabetes and hypertension) and AHRQ referral sensitive surgeries (e.g., percutaneous Tran's luminal coronary angioplasty [PTCA] and knee replacement). To evaluate quality and patient outcomes we will use AHRQ Inpatient Quality Indicators (IQI), comprising of eight surgical (e.g., esophageal resection) and six medical admission conditions (e.g., acute myocardial infarction [AMI]). Our aims are to estimate the following indicators for Hispanics, non-Hispanic Blacks and non-Hispanic Whites aged e 21: (a) population-level rates of admission for PQIs, referral sensitive surgeries and IQIs and (b) risk-adjusted rates of inpatient mortality, 30-day mortality and 30-day readmissions following admission for IQI medical or surgical admission. We will also estimate the extent to which differences in risk-adjusted rates Hispanics are associated with the hospitals where they are treated. The proposal is innovative and significant: representative estimates of inpatient care utilization and their outcomes for Hispanics have never been presented~ they will establish measurable target indicators, help set national priorities, and wil provide a mechanism with which to judge the relative impact of new policy initiatives for minorities by ethnicity and race.