Agency for Healthcare Research and Quality, Rockville, Maryland 20850, USA.
Soc Work Public Health. 2011;26(6):605-20. doi: 10.1080/19371911003748778.
The purpose of the study is to identify patient attributes associated with teaching hospital admissions in the elderly for coronary artery bypass graft (CABG), and to determine whether admission patterns in teaching hospitals by vulnerable subgroups of the elderly changed during 1997 to 2001, a period with significant changes in CABG admission patterns and financial situation faced by teaching hospitals. The study sample comprises elderly residents in two states, New York and Pennsylvania, and uses Healthcare Cost and Utilization Project State Inpatient data of the Agency for Health Care Research and Quality. Patient characteristics in major teaching hospitals are compared with those in rest of hospitals in a logistic regression framework using a pre-/postdesign, and controlling for county characteristics and resources, distance to hospitals, and hospital size and volume of procedures. Significant patient characteristics associated with a higher likelihood of admission to teaching hospitals included racial/ethnic minority status, transfer cases, Medicaid and private health maintenance organization insurance. A lower volume of CABG cases and an increased propensity to admit more complex cases characterized the admission patterns in teaching hospitals during 1997 to 2001. Although higher use of teaching hospitals by racial/ethnic minorities persisted, access for Medicaid patients disproportionately declined.
本研究旨在确定与老年患者接受冠状动脉旁路移植术（CABG）相关的教学医院入院因素，并确定在 1997 年至 2001 年期间，教学医院对老年人弱势群体的入院模式是否发生变化，在此期间，CABG 入院模式和教学医院面临的财务状况发生了重大变化。研究样本包括纽约州和宾夕法尼亚州的两位老年人居民，使用 Agency for Health Care Research and Quality 的 Healthcare Cost and Utilization Project State Inpatient 数据。在逻辑回归框架中，使用前后设计并控制县特征和资源、到医院的距离、医院规模和手术量，比较主要教学医院的患者特征与其他医院的患者特征。与更高的教学医院入院可能性相关的显著患者特征包括种族/民族少数群体地位、转院病例、医疗补助和私人健康维护组织保险。1997 年至 2001 年期间，教学医院的入院模式以 CABG 手术量较低和更倾向于收治更复杂病例为特征。尽管少数民族群体更多地使用教学医院，但医疗补助患者的获得机会不成比例地下降。
