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

描述(由申请者提供)：项目摘要：拉美裔美国人现在是美国最大的少数民族或少数族裔。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。由于保险率较高、贫困和健康素养不足，拉美裔美国人也面临着更大的医疗保健障碍风险。然而，在全国范围内，人们对拉美裔患者的住院护理机会、质量或出院结果知之甚少。这在很大程度上是因为在国家住院护理数据来源中对拉美裔对象的识别不力。这种知识差距限制了“制定和监督国家目标、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的估计进行比较。我们将研究15个州的SID数据(2010-11)，这些州加起来占全国拉美裔成年人口的87%以上。我们将检查不同护理领域的一系列住院护理指标。AS 作为获得护理的指标，我们将使用医疗研究质量署(AHRQ)、预防质量指标(PQI)(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)确定的ACSC条件。为了评估质量和患者预后，我们将使用AHRQ住院患者质量指标(IQI)，包括8个手术(例如食道切除)和6个入院条件(例如急性心肌梗死(AMI))。我们的目标是估计西班牙裔、非西班牙裔黑人和非西班牙裔白人e 21岁的以下指标：(A)人群水平的PQI、转诊敏感手术和IQI的入院率，以及(B)住院死亡率、30天死亡率和因IQI内科或外科入院后30天再入院的风险调整比率。我们还将估计拉美裔美国人风险调整比率的差异与他们接受治疗的医院之间的联系程度。这项提案具有创新性和重要意义：从未提出过对拉美裔住院护理利用率及其结果的代表性估计--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，用于根据种族和种族来判断新政策举措对少数族裔的相对影响。

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.