医院竞争与前列腺癌护理质量之间的关联
Ravishankar Jayadevappa1,2,3,4, S Bruce Malkowicz5,6, Neha Vapiwala6,7
1Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US. jravi@pennmedicine.upenn.edu.
BMC health services research
|August 5, 2023
概括
较低的医院竞争与老年前列腺癌患者,特别是非裔美国人的结果更差有关. 这种差异凸显了需要了解竞争如何影响护理质量和种族差异.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 在瘤学瘤学.
- 卫生经济学 卫生经济学
背景情况:
- 医院对美国经济做出了重大贡献.
- 了解医院竞争对患者结果的影响至关重要.
研究的目的:
- 检查医院竞争与局部前列腺癌 (PCa) 的老年患者的结果之间的关联.
- 评估种族是否会缓和医院竞争和PCa结果之间的关系.
主要方法:
- 对SEER-Medicare数据库 (1997-2016) 的回顾性分析.
- 包括253176名年龄66岁以上的服务费医疗保险受益者,他们有局部PCa.
- 使用希尔施曼-赫芬达尔指数 (HHI) 衡量医院竞争;结果包括急诊室访问,住院,支出和死亡率.
主要成果:
- 增加的HHI (较低的竞争) 与更高的ER访问率相关 (每单位HHI增加17%),非洲裔美国人的增加更大 (48%) 比白人 (24%).
- 较低的竞争与白人短期死亡率 (7%) 的增加有关,但非洲裔美国人 (11%).
- 随着白人 (10%) 和非裔美国人 (13%) 的竞争减少,长期死亡风险增加.
结论:
- 减少医院竞争与局部前列腺癌护理的较差结果有关.
- 较低竞争对结果的负面影响在非洲裔美国患者中比白人患者更为明显.
- 需要进一步的研究来阐明将竞争,结果和PCa护理中的种族差异联系在一起的机制.
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