对抗抑郁药物药物管理质量的种族和种族差异
Alex H S Harris1,2, Pingyang Liu1, Jessica Y Breland1
1Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.
Health services research
|July 5, 2024
概括
抗抑郁药物管理质量的差异不成比例地影响设施内的黑人患者. 西班牙裔患者经历的差异主要是由于设施级别的绩效差异. 解决这些问题需要一个多维的方法.
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
- 改善心理健康质量 改善心理健康质量
背景情况:
- 抗抑郁药物管理 (AMM) 的质量可能会有很大的差异.
- 了解差异需要区分设施之间的质量差异和设施内的质量差异.
研究的目的:
- 通过使用多维框架分析AMM质量的差异.
- 在AMM质量方面区分设施间与设施内部的差异.
主要方法:
- 使用的退伍军人卫生管理局 (VA) 企业数据仓库 (CDW) 数据.
- 采用混合效应回归和Kitagawa-Blinder-Oaxaca (KBO) 分解方法.
- 评估了包括HEDIS措施在内的5个AMM质量指标,用于2017财年.
主要成果:
- 黑人患者不管在哪个机构,都不太可能满足AMM质量标准 (例如,初始处方,急性/延续阶段).
- 西班牙裔患者的差异更多地与他们接受护理的设施的整体表现较差有关.
- 对黑人患者来说,观察到的差异最多是"设施内部",表明系统性问题.
结论:
- 对有针对性的干预来说,区分设施内部和设施之间的差异至关重要.
- 对质量的多维观点对于有效解决AMM差异至关重要.
- 调查结果强调需要在设施层面进行质量改进,并为不同种族/民族群体量身定制战略.
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