Lowe R A, Chhaya S, Nasci K, Gavin L J, Shaw K, Zwanger M L, Zeccardi J A, Dalsey W C, Abbuhl S B, Feldman H, Berlin J A
Department of Biostatistics and Epidemiology, University of Pennsylvania Medical Center, and Philadelphia Emergency Medicine Research Consortium, Philadelphia, PA, USA.
Acad Emerg Med. 2001 Mar;8(3):259-66. doi: 10.1111/j.1553-2712.2001.tb01302.x.
After a pilot study suggested that African American patients enrolled in managed care organizations (MCOs) were more likely than whites to be denied authorization for emergency department (ED) care through gatekeeping, the authors sought to determine the association between ethnicity and denial of authorization in a second, larger study at another hospital.
A retrospective cohort design was used, with adjustment for triage score, age, gender, day and time of arrival at the ED, and type of MCO.
African Americans were more likely to be denied authorization for ED visits by the gatekeepers representing their MCOs even after adjusting for confounders, with an odds ratio of 1.52 (95% CI = 1.18 to 1.94).
African Americans were more likely than whites to be denied authorization for ED visits. The observational study design raises the possibility that incomplete control of confounding contributed to or accounted for the association between ethnicity and gatekeeping decisions. Nevertheless, the questions that these findings raise about equity of gatekeeping indicate a need for additional research in this area.
一项初步研究表明，参加管理式医疗组织（MCO）的非裔美国患者比白人更有可能因守门制度而被拒绝获得急诊科（ED）护理授权。作者试图在另一家医院进行的第二项规模更大的研究中确定种族与授权拒绝之间的关联。
采用回顾性队列设计，并对分诊评分、年龄、性别、到达急诊科的日期和时间以及MCO类型进行了调整。
即使在对混杂因素进行调整之后，代表其MCO的守门人拒绝非裔美国人进行急诊就诊授权的可能性仍然更高，优势比为1.52（95%置信区间=1.18至1.94）。
非裔美国人比白人更有可能被拒绝获得急诊就诊授权。观察性研究设计增加了这样一种可能性，即对混杂因素的不完全控制促成或解释了种族与守门决策之间的关联。尽管如此，这些发现所引发的关于守门公平性的问题表明，该领域需要更多的研究。
