医院护理提供和健康结果的分离模式
Sunny C Lin1,2,3, Gmerice Hammond4, Michael Esposito5
1Division of General Medical Sciences, Washington University School of Medicine in St Louis, St Louis, Missouri.
JAMA health forum
|November 22, 2023
概括
医院隔离,即患者因种族而在不同的设施接受护理,与更糟糕的健康结果有关. 这种差异不成比例地影响了黑人人口,突出了种族隔离是健康不平等的关键驱动因素.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生公平研究 卫生公平研究
- 卫生社会学 卫生社会学
背景情况:
- 住宅隔离是已知的种族健康不平等的驱动因素.
- 目前医院护理隔离的模式及其对健康结果的影响仍未得到充分研究.
- 解决医院隔离问题对于改善医疗保健中的种族平等至关重要.
研究的目的:
- 描述当代医院护理中的种族隔离.
- 确定与医院隔离相关的市场级因素.
- 确定医院隔离与健康结果之间的关联.
主要方法:
- 使用2018年医疗保险索赔,美国社区调查和健康社会决定因素数据进行的横截面研究.
- 分析医院转诊区域 (HRRs) 的隔离模式,使用不相似性和隔离指数.
- 线性回归来检查医院隔离与健康结果 (预防质量指标,心脏病/中风死亡率) 之间的关联.
主要成果:
- 在医院护理中观察到明显的种族隔离,黑人和白人患者在不同的医院接受护理 (平均不相似指数:23,隔离指数:13).
- 医院隔离与住宅隔离相关 (相关系数:不相似的0.58,隔离的0.90).
- 增加的医院隔离与急性和慢性住院率的增加以及黑人和白人患者的死亡率的增加有关,黑人群体的不良影响更大.
结论:
- 更高的医院护理隔离与更差的健康结果有关,强调种族隔离是健康差异的根本原因.
- 调查结果支持需要政策解决种族隔离在住宅和医疗机构设置.
- 建议包括支付改革和扩大医疗保险覆盖范围,以减轻这些差异.
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