Burstin H R, Lipsitz S R, Brennan T A
Division of General Medicine, Brigham and Women's Hospital, Boston, MA 02115.
JAMA. 1992 Nov 4;268(17):2383-7.
To assess whether the socioeconomic status of the patient was associated with the risk of adverse events, defined as medical injuries caused by medical management, and the proportion of these events that resulted from substandard care.
51 hospitals in New York State.
Rates of medical injury and substandard care by gender, race, income, and payer status were developed from reviews of 30,195 medical records in New York in 1984. We evaluated these socioeconomic parameters in a multivariate analysis, while controlling for hospital-level factors.
We found that uninsured patients (odds ratio, 2.35; 95% confidence interval, 1.40 to 3.95) were at greater risk for substandard care. The characteristics of the hospitals to which patients were admitted did not affect this result. Race, gender, and income were not independently associated with risk for medical injury or substandard care in multivariate analyses.
Our findings suggest that the uninsured are at greater risk for suffering medical injury due to substandard medical care.
评估患者的社会经济地位是否与不良事件风险相关，不良事件定义为医疗管理导致的医疗伤害，以及这些事件中因护理不达标所致的比例。
纽约州的51家医院。
通过对1984年纽约30195份病历的审查，得出按性别、种族、收入和付款人身份划分的医疗伤害率和护理不达标率。我们在多变量分析中评估这些社会经济参数，同时控制医院层面的因素。
我们发现未参保患者（比值比，2.35；95%置信区间，1.40至3.95）接受不达标的护理风险更高。患者入院的医院特征并未影响这一结果。在多变量分析中，种族、性别和收入与医疗伤害风险或护理不达标并无独立关联。
我们的研究结果表明，未参保者因护理不达标而遭受医疗伤害的风险更高。
