The Josiah Macy Jr. Foundation, New York, NY 10065, USA.
J Public Health Policy. 2011 Nov;32(4):407-29. doi: 10.1057/jphp.2011.42. Epub 2011 Aug 25.
This article examines associations of socio-demographic and health-care indicators, and the statistic 'mortality amenable to health care' (amenable mortality) across the US states. There is over two-fold variation in amenable mortality, strongly associated with the percentages of state populations that are poor or black. Controlling for poverty and race with bi- and multi-variate analyses, several indicators of health system performance, such as hospital readmission rates and preventive care for diabetics, are significantly associated with amenable mortality. A significant crude association of 'uninsurance' and amenable mortality rates is no longer statistically significant when poverty and race are controlled. Overall, there appear to be opportunities for states to focus on specific modifiable health system performance indicators. Comparative rates of amenable mortality should be useful for estimating potential gains in population health from delivering more timely and effective care and for tracking the health outcomes of efforts to improve health system performance.
本文研究了美国各州的社会人口和医疗保健指标以及“可归因于医疗保健的死亡率”（可归因死亡率）之间的关联。可归因死亡率存在两倍以上的差异，与贫困或黑人在州人口中的比例密切相关。通过双变量和多变量分析控制贫困和种族因素后，几项卫生系统绩效指标（如医院再入院率和糖尿病预防保健）与可归因死亡率显著相关。在控制贫困和种族因素后，“无保险”与可归因死亡率之间的显著粗关联不再具有统计学意义。总体而言，各州似乎有机会专注于特定的可修改的卫生系统绩效指标。可归因死亡率的比较比率可用于估计通过提供更及时和有效的护理来提高人口健康的潜力，并跟踪改善卫生系统绩效的努力的健康结果。
