护理连续性,科医生对透析设施的偏好,以及结果
Eugene Lin1,2,3, Khristina I Lung2, Derick Rapista2
1Department of Medicine, Division of Nephrology, Keck School of Medicine of the University of Southern California, Los Angeles.
JAMA health forum
|April 11, 2025
概括
患者经常在科医生的机构开始透析以保持连续性,即使质量低,也会不成比例地影响少数群体. 改善获得高质量的透析设施的机会对于解决这些差异至关重要.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 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:
- 开始透析的患者可以通过选择他们的科医生的主要设施来优先考虑护理的连续性,无论设施质量如何.
- 这种做法可能会导致低于最佳的透析开始体验,特别是对于来自少数种族和族裔群体的患者.
研究的目的:
- 调查在科医生的初级设施中开始透析的流行情况.
- 分析下游健康结果和与透析开始质量相关的种族差异.
- 检查设施质量和接近对患者选择的影响.
主要方法:
- 一项使用美国独立透析设施 (2015-2020) 的医疗保险行政数据的队列研究.
- 分析包括了143,776名有费用服务医疗保险启动透析的成年患者.
- 多变量回归模型评估了设施质量 (五星级),邻近性和死亡率和住院等结果之间的关联,控制了医院服务区域固定的影响.
主要成果:
- 透析开始于科医生的初级设施随着设施质量的提高而减少.
- 更高质量的初级设施与更高质量的开始和更少的住院病例有关.
- 黑人患者比白人患者更不太可能在高质量的设施中开始透析,更不太可能有具有高质量的初级设施的科医生.
结论:
- 在低质量的初级设施中启动透析是常见的,导致患者的治疗结果更差.
- 存在显著的种族差异,黑人患者不成比例地在质量较差的设施开始透析.
- 需要政策干预,促进获得高质量的透析设施,以减轻这些差异.
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