アドバンス・ケア・プランニング,人種,年齢
Rebecca E Berger1, Monika M Safford1, Jennifer I Lee1
1Division of General Internal Medicine, Weill Department of Medicine, Weill Cornell Medicine, New York, NY.
まとめ
一般医療の入院患者の事前ケアプランニング (ACP) サービスにおける人種差異は,患者要因を調整した後も観察されなかった. 健康格差を理解し,対処するためにさらなる分析が必要である.
科学分野:
- 医療サービス 研究 医療サービス
- 健康の格差について
- 医療情報工学 医療情報工学
背景:
- 終末期ケアと事前ケア計画 (ACP) の人種差は文書化されています.
- これらの格差が他の変数によって説明されるかどうかは不明である.
研究 の 目的:
- 一般医療の入院患者の間でACPサービスにおける人種的格差が,潜在的な混同要因を調整した後も持続するかどうかを判断する.
- 人口統計学的および臨床的要因が,ACPの供給に与える影響を調査する.
主な方法:
- 学術医療センターからの電子医療記録の二次分析.
- 2022年7月~2023年6月間に退院した,寿命が限られた一般医療入院患者も含まれています.
- 患者の特徴とACPサービス (緩和ケア相談,ホスピス退院,快適ケア,またはACPノート) の関連性を分析するためにポアソン回帰を使用しました.
主要な成果:
- 分析対象は552人の患者の580件の入院 (平均年齢73.8歳,非ヒスパニック系白人51.3%) でした.
- 調整されていない分析では,非ヒスパニック系黒人の患者は,ACPのサービスを受ける可能性が低いことが示されました.
- 年齢,性別,保険,病状に合わせて調整することで,明らかに人種的格差がなくなりました.
結論:
- 一般医療の入院患者の間でのACPサービスにおける明らかな人種的格差は,混同要因を調整した後も持続しなかった.
- 質の改善における健康格差の正確な評価には,潜在的な混同変数への調整が必要です.
- さらなる研究は,多様な患者集団におけるACPの提供に影響を与える微妙な要因を探求する必要があります.
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