在退伍军人卫生管理局的区域剥夺,分散的护理和大肠切除病例急性
Robert A Tessler1,2, Mary S Vaughan Sarrazin3,4, Yubo Gao3,4
1Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
高贫困地区的退伍军人面临着因良性疾病而出现的集体切除的风险增加. 分散的护理也提高了所有征兆的新兴切除术风险,突出了针对性干预的需要.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 外科手术的结果
- 健康差异 在健康上的差异
背景情况:
- 与非选择性切除术相比,非选择性切除术与较差的结果有关.
- 关于区域剥夺和护理分散对非选择性切除术的影响的理解有限.
- 这项研究调查了退伍军人卫生管理局 (VHA) 人口中的这些因素.
研究的目的:
- 在VHA中确定面积剥夺和非选择性切除术之间的关联.
- 评估护理碎片化是否会改变这种关联在不同指示 (良性与恶性) 中.
- 评估剥夺和分裂对集体切除结果的独立和联合影响.
主要方法:
- 65岁或以上的退伍军人接受了切除术 (2013-2019) 的回顾性队列研究.
- 多变量多项逻辑模型用于分析高贫困,护理碎片化和非选择性切除术之间的关联.
- 分析包括计算总,直接和间接影响,以了解因素的相互作用.
主要成果:
- 高面积的剥夺与良性疾病 (aOR 1.51) 的新兴集体切除率增加有关.
- 在高剥夺和非选择性切除术之间没有发现有意义的关联,用于恶性征兆.
- 增加的护理碎片化与更高的紧急和新出现的胆管切除术的几率相关,无论是良性还是恶性疾病.
结论:
- 在高贫困地区的退伍军人有较高的风险,因良性疾病而出现集体切除术.
- 护理的碎片化独立地增加了新出现的胆管切除术的风险,无论指示.
- 减少护理碎片化和改善服务不足地区早期检测的干预措施可能会减轻非选择性切除风险.
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