共享决策降低医疗费用,这种效应在种族和种族一致的关系中得到扩大
Timothy T Brown1, Vanessa B Hurley2, Hector P Rodriguez1,3
1University of California, Berkeley, Berkeley, CA.
Medical care
|June 12, 2023
概括
共享决策 (SDM) 降低了所有种族群体的医疗保健成本. 这种节省成本的效果在黑人患者与黑人临床医生之间显著放大,突出了在医疗保健中种族一致的重要性.
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
- 卫生经济学 卫生经济学
背景情况:
- 在医疗保健提供中,种族种族差异很普遍.
- 共享决策 (SDM),包括有效的临床医生与患者沟通,可能会影响这些差异.
- SDM质量的变化可能会影响患者的治疗结果和医疗保健利用率.
研究的目的:
- 调查SDM对医疗保健结果的因果影响.
- 检查SDM的影响是否在种族/种族一致的临床医生与患者关系中更为明显.
- 确定在医疗保健中的种族种族差异背后的潜在机制.
主要方法:
- 利用仪器变量来估计SDM的因果作用.
- 分析了60584名患者的数据,使用医学支出小组调查 (2003-2017).
- 由于影响SDM指数的调查修改,不包括2018-2019年的数据.
主要成果:
- 在所有种族和民族群体中,SDM减少了年度卫生总支出.
- 与白人患者相比,SDM的成本降低效应在由黑人临床医生治疗的黑人患者中大大增加.
- 在黑人患者和黑人临床医生以及西班牙裔患者与西班牙裔临床医生之间观察到SDM对门诊费用的类似放大效应.
- 没有发现SDM对自我报告的身体或精神健康有重大影响.
结论:
- 高质量的SDM可以降低医疗保健支出,而不会对健康产生不利影响.
- 医疗保健系统有商业案例来增强种族-种族临床医生-患者一致性.
- 改善一致性,特别是对于黑人和西班牙裔患者,可能会减轻医疗保健成本差异.
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