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

全国住院护理、结果估计

• 批准号: 8478771
• 负责人: Amresh D Hanchate
• 金额: $ 42.52万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2018-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8478771
• 关键词: Accounting; Acute myocardial infarction; Address; Admission activity; Adult; Ambulatory Care; American; Benchmarking; Caring; Censuses; Cessation of life; Data; Data Set; Data Sources; Databases; Death Rate; Death Records; Diabetes Mellitus; Elderly; Ensure; Esophageal; Ethnic Origin; Excision; Health; Health Services Accessibility; Health Status; Health behavior; Healthcare; High Prevalence; Hispanics; Hospitalization; Hospitals; Hypertension; Inpatients; Insurance; Knowledge; Measurable; Medical; Medicare; Methods; Minority; Monitor; Not Hispanic or Latino; Obesity; Operative Surgical Procedures; Outcome; Patient Admission; Patient Self-Report; Patients; Pattern; Percutaneous Transluminal Coronary Angioplasty; Policies; Population; Poverty; Prevention; Quality Indicator; Quality of Care; Race; Relative (related person); Risk; Risk Estimate; Role; Sampling; Socioeconomic Status; Statutes and Laws; Subgroup; Surveys; United States Agency for Healthcare Research and Quality; aged; base; coronary angioplasty; design; ethnic difference; evidence base; health care service utilization; health literacy; innovation; knee replacement arthroplasty; meetings; mortality; novel strategies; public health relevance; statistics

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.

描述（由申请人提供）： 项目摘要 拉美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着差异。拉美裔人也面临更大的风险，由于较高的保险率，贫困和健康素养不足，医疗保健准入障碍。 然而，很少有人知道住院治疗的机会，质量或出院结果之间的西班牙裔国家。这在很大程度上是由于在国家住院治疗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。 我们建议使用一种新颖的方法，将州住院患者出院（SID）数据与人口普查人口数据沿着，以获得西班牙裔成年人住院护理利用率的代表性估计值，并将其与非西班牙裔白人和非西班牙裔黑人的估计值进行对比。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。 我们将研究不同护理领域的一系列住院护理指标。作为 获得护理的指标，我们将使用由医疗保健研究质量机构（AHRQ）预防质量指标（PQI）确定的ACSC条件（例如，糖尿病和高血压）和AHRQ转诊敏感手术（例如，经皮冠状动脉腔内成形术[PTCA]和膝关节置换术）。为了评估质量和患者结局，我们将使用AHRQ住院患者质量指标（IQI），包括八个外科（例如，食管切除术）和六种医疗入院条件（例如，急性心肌梗死[AMI]）。 我们的目的是估计年龄在21岁以上的西班牙裔、非西班牙裔黑人和非西班牙裔白人的以下指标：（a）PQI、转诊敏感手术和IQI的人口水平入院率，以及（B）IQI内科或外科入院后住院死亡率、30天死亡率和30天再入院率的风险调整率。我们还将估计西班牙裔美国人的风险调整率与他们接受治疗的医院之间的差异程度。 该提案具有创新性和重要性：对西班牙裔患者的住院治疗利用率及其结果的代表性估计从未提出过，它们将建立可衡量的目标指标，帮助设定国家优先事项，并将提供一种机制，以判断新政策举措对少数民族的相对影响。