Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, Maryland 20850, USA.
Acad Pediatr. 2010 Mar-Apr;10(2):95-118. doi: 10.1016/j.acap.2009.12.005.
The aim of this study was to explore the joint effect of race/ethnicity and insurance status/expected payer or income on children's health care quality.
The analyses are based on data from a nationally representative random sample of children in the United States in 2004 and 2005 from the Medical Expenditure Panel Survey (MEPS) and pediatric hospitalizations from a nationwide sample of hospitals in 2005 from the State Inpatient Databases disparities analysis file from the Healthcare Cost and Utilization Project (HCUP). We provide estimates of differences in race/ethnicity within income and insurance/expected payer categories on key pediatric quality indicators to provide a more nuanced understanding of disparities in care for children. Our indicators of quality cover several domains from the Institute of Medicine report, including effectiveness, patient centeredness, timeliness, and patient safety.
Across a broad set of 23 quality indicators, findings indicate that racial/ethnic disparities vary by income levels and types of insurance. Key highlights include the finding that racial/ethnic differences within income or insurance/payer groups are more pronounced for some racial/ethnic groups than others. Hispanic children followed by Asian children had worse quality than whites as measured by the majority of quality indicators. Exceptions included rates of admissions for diabetes, admissions for gastroenteritis, accidental puncture during procedures, and decubitus ulcers. Many indicators showed less than ideal quality for all subgroups of children, even whites with private insurance.
The extensive findings in this report make clear that patterns of racial/ethnic disparity vary by income and insurance/expected payer subgroup. However, disparities in quality are not similar across all measures of quality, and strategies to address these disparities need to be designed with these nuances in mind.
本研究旨在探讨种族/民族与保险状况/预期支付者或收入对儿童医疗保健质量的联合影响。
本分析基于美国 2004 年和 2005 年医疗支出面板调查（MEPS）中具有全国代表性的儿童随机样本数据，以及来自医疗保健成本和利用项目（HCUP）国家住院患者数据库差异分析文件的 2005 年全国医院抽样儿童住院数据。我们提供了在收入和保险/预期支付者类别内不同种族/民族在关键儿科质量指标上的差异估计值，以更细致地了解儿童护理方面的差异。我们的质量指标涵盖了医学研究所报告中的几个领域，包括有效性、以患者为中心、及时性和患者安全性。
在 23 个广泛的质量指标中，研究结果表明，种族/民族差异因收入水平和保险类型而异。主要发现包括，在收入或保险/支付者群体内部，某些种族/民族群体的种族/民族差异比其他群体更为明显。与白人相比，西班牙裔儿童和亚裔儿童在大多数质量指标下的医疗质量较差。例外情况包括糖尿病入院率、肠胃炎入院率、手术过程中意外穿刺和褥疮。即使是拥有私人保险的白人儿童，许多指标的质量也不尽如人意。
本报告的广泛发现明确表明，种族/民族差异的模式因收入和保险/预期支付者亚组而异。然而，质量差异在所有质量衡量标准中并不相似，解决这些差异的策略需要考虑到这些细微差别。
