Pearson M L, Kahn K L, Harrison E R, Rubenstein L V, Rogers W H, Brook R H, Keeler E B
Health Program of RAND, Santa Monica, CA 90407-2138.
JAMA. 1992 Oct 14;268(14):1883-9.
To analyze whether important gender differences exist in the quality of hospital care provided to patients with four major medical conditions.
Bivariate and multivariate comparisons of clinically detailed sickness at admission, quality, utilization, and outcome measures.
Acute care hospitals located in five states.
A total of 11,242 patients 65 years or older who were hospitalized with one of four diseases: congestive heart failure, acute myocardial infarction, pneumonia, and cerebrovascular accident. We derived our data from the nationally representative sample used to study the quality of hospital care for Medicare patients before and after the implementation of the prospective payment system. A hierarchical (nested) cluster sampling design was used to draw disease-specific samples of patients hospitalized in 1981, 1982, 1985, or 1986 in one of 297 hospitals located in 30 areas within five states.
This was an observational study.
Sickness at admission, process, use rates, length of stay, discharge status, discharge destination, and mortality.
Sex differences in sickness at admission varied by disease. There was some evidence that women received worse process of care, but the difference was very small. We found many similarities in the process and outcomes of care for male and female patients.
After controlling for sickness at admission, age, and other important covariates, the in-hospital experiences of elderly men and women showed greater similarities than differences. The concern that sex bias enters into clinical decision making during hospitalization is eased, although not entirely eliminated.
分析在为患有四种主要疾病的患者提供医院护理的质量方面是否存在重要的性别差异。
对入院时临床详细病症、质量、利用率和结果指标进行双变量和多变量比较。
位于五个州的急症医院。
共有11242名65岁及以上的患者，他们因以下四种疾病之一住院：充血性心力衰竭、急性心肌梗死、肺炎和脑血管意外。我们的数据来自用于研究预期支付系统实施前后医疗保险患者医院护理质量的全国代表性样本。采用分层（嵌套）整群抽样设计，从五个州30个地区的297家医院中，抽取1981年、1982年、1985年或1986年住院的特定疾病患者样本。
这是一项观察性研究。
入院时的病症、治疗过程、使用率、住院时间、出院状态、出院去向和死亡率。
入院时的病症性别差异因疾病而异。有证据表明女性接受的护理过程较差，但差异非常小。我们发现男性和女性患者在护理过程和结果方面有许多相似之处。
在控制了入院时的病症、年龄和其他重要协变量后，老年男性和女性的住院经历显示出更多的相似之处而非差异。尽管住院期间临床决策中存在性别偏见的担忧并未完全消除，但有所缓解。
