医院住院的黑人和穷人的医疗保健 医疗保险患者
K L Kahn1, M L Pearson, E R Harrison
1Health Program of RAND, Santa Monica, CA.
JAMA
|April 20, 1994
概括
对老年医疗保险患者的医院护理中的种族和社会经济差异受医院类型的影响. 虽然黑人患者和来自贫困社区的患者接受了较差的护理过程,但他们更有可能在更高质量的城市教学医院接受治疗,以平衡整体质量.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 健康 公平 卫生 公平
- 医院的质量 医院的质量
背景情况:
- 在获得医疗保健和医疗保健质量方面,种族和社会经济差异仍然存在.
- 了解患者特征如何与医疗保健系统相互作用,对于改善公平的医疗保健服务至关重要.
研究的目的:
- 调查老年黑人患者或来自贫困社区的患者是否得到了不理想的医院护理.
- 为了解释医院层面的护理质量和患者结果的变化.
主要方法:
- 一项观察性研究分析了9932名65岁以上的医疗保险患者的全国代表性样本.
- 对黑人患者和来自贫困社区的患者与其他患者的护理过程,结果和医院类型的比较.
- 包括因充血性心力衰竭,急性心肌梗塞,肺炎或中风住院的患者在五个州的297家医院.
主要成果:
- 黑人或来自贫困社区的患者在医院类型之间经历了更糟糕的护理过程和更大的出院不稳定性.
- 这些差异被更高的可能性 (1.8倍) 接受城市教学医院的护理部分抵消了,这些医院提供更高质量的护理.
- 根据种族或贫困状况,由于这种护理再分配,没有发现护理质量或死亡率的重大总体差异.
结论:
- 医疗保险老年人的医院护理质量 医疗保险患者的医院护理质量是患者种族,社会经济地位和提供护理的医院类型的复杂相互作用.
- 虽然个体患者因素可能导致护理过程中的差异,但不同类型医院的患者分布可以减轻或加剧这些差异.
- 医疗保健系统必须考虑患者层面和医院层面的因素,以确保所有人群的公平和高质量的护理.
相关概念视频
01:18Introduction To Health Care Delivery System
The healthcare system is constantly changing and complex. Various services are available from different healthcare providers, but gaining access to these services has become challenging for people with limited healthcare insurance. Uninsured people present a challenge to healthcare because they frequently postpone or forego treatment.
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
01:26Methods Of Healthcare Delivery System
At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
01:26Traditional Level Of Health Care System
The levels of care describe the services provided in the healthcare system. Accordingly, there are six levels of the traditional healthcare system in the US: preventive, primary, secondary, tertiary, restorative, and continuing healthcare. A nurse must understand how the healthcare industry organizes and provides services within these levels of care.
The preventive healthcare service includes tests for screening. Preventive health care services include identifying and reducing disease risk...
The preventive healthcare service includes tests for screening. Preventive health care services include identifying and reducing disease risk...
01:28Hospitals-I
Hospitals offer medical and surgical care to the sick and injured, along with accommodation while they recover. At the same time, they also provide outpatient, emergency, psychiatric, and rehabilitation services to meet various community needs. In addition to providing medical care, hospitals also act as hubs for medical research and training. Hospitals use clinical procedures and evidence-based practice standards to deliver patient care. To deliver safe and efficient care, a nurse must stay up...
01:30Specialized Care Centers and Settings-II
Rural Health Centers
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
00:59Hospitals-II
Hospitals provide inpatient and outpatient services. Inpatient services provide care to patients that stay in the hospital for an extended period, ranging from days to months. Examples of inpatient services include intensive care units, hospital wards, or surgeries. Outpatient services provide care to patients who come to a hospital for a diagnostic or treatment but do not stay overnight —for example, diagnostic tests, surgical procedures, or health education.
Nurses that work in hospitals have...
Nurses that work in hospitals have...