在抗凝血治疗心房的种族差异中设施级别的变化:REACH-AF研究
Utibe R Essien1,2, Nadejda Kim3, Leslie R M Hausmann3,4
1HSRD Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA. utibe.essien@va.gov.
Journal of general internal medicine
|February 2, 2024
概括
在VA设施内,对于心房动 (AF) 患者的抗凝剂处方存在种族差异. 观察到设施级别的显著变化和调整后的风险差异,突出了AF护理质量改善的领域.
科学领域:
- 心脏病学 心脏病学
- 医疗保健服务研究 医疗服务研究
- 健康 公平 卫生 公平
背景情况:
- 口服抗凝药对于降低心房动 (AF) 患者中风风险至关重要.
- 以前的研究表明,与白人相比,黑人人处方抗凝剂的比例较低.
- 有限的研究探讨了AF患者在设施级别处方抗凝剂的种族差异.
研究的目的:
- 评估在退伍军人卫生管理局 (VA) 设施内的基于种族的抗凝剂启动的变化.
- 为了确定在不同VA设施中对AF患者启动抗凝药治疗的潜在种族差异.
主要方法:
- 追溯队列研究设计.
- 在VA系统中,包括在2020年至2021年期间被诊断患有事件AF的黑人和白人患者.
- 主要结局:在AF诊断后90天内使用任何抗凝剂 (华法林或直接口服抗凝剂[DOAC]) 或开始DOAC治疗的比率,分析每个设施内的整体和种族. 经调整的黑白风险差异被估计.
主要成果:
- 分析包括82个VA设施的26,832名黑人和白人患者.
- 对于任何抗凝剂 (56.8%87.1%) 和DOAC治疗 (55.1%85.5%) 的未调整率,观察到有显著的设施水平变化.
- 黑人和白人患者之间的调整后风险差异在各医院不同,一些医院在统计学上显示白人患者的处方率更高,无论是任何抗凝剂还是DOAC治疗.
结论:
- 在VA系统内的AF患者的国家队列表明,抗凝剂和DOAC启动的设施级别的变化很大.
- 在治疗开始时发现了显著的调整后的种族风险差异,这突显了护理方面的差异.
- 这些发现突出了当地质量改善计划的具体目标,旨在提高AF护理公平性.
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