在使用大量医院进行复杂手术方面存在差异
Jerome H Liu1, David S Zingmond, Marcia L McGory
1Center for Surgical Outcomes and Quality, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif, USA.
JAMA
|October 26, 2006
概括
少数民族和低收入患者不太可能在高人数的医院接受护理,尽管建议这样的转诊. 解决这些差异需要确定患者和系统因素,以确保公平获得大量护理.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 健康差异 在健康上的差异
- 外科手术的结果
背景情况:
- 对于经过证明的体积与结果关系的手术,建议使用高体积的医院.
- 患者的特点可能会影响获得大量护理的机会.
- 了解这些差异对于公平的医疗保健服务至关重要.
研究的目的:
- 识别与使用大量医院相关的患者特征.
- 分析获得专门手术护理的差异.
主要方法:
- 在加利福尼亚州 (2000-2004) 进行了719608次住院手术的回顾性分析.
- 检查了10项主要的外科手术程序,包括选择性腹腔大动脉动脉瘤修复和冠状动脉旁路移植.
- 患者种族/种族和保险状况的比较,大体积 (20%) 和低体积 (20%) 的医院.
主要成果:
- 非白人,医疗补助和没有保险的患者在大量医院接受护理的可能性明显低.
- 黑人,亚裔和西班牙裔患者在多种手术中显示,高体积护理的可能性降低.
- 与医疗保险患者相比,医疗补助和无保险患者在大量设施接受治疗的几率要低得多.
结论:
- 在大量医院治疗的患者群体中存在显著的差异.
- 目前的转诊做法可能会加剧医疗保健不平等.
- 需要明确的策略,以确保所有患者群体均可获得高体积护理.
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