Department of Healthcare Policy and Research, Massey Cancer Center, Virginia Commonwealth University, PO Box 980430, Richmond, VA 23298-0430, USA.
Health Serv Res. 2012 Apr;47(2):677-97. doi: 10.1111/j.1475-6773.2011.01328.x. Epub 2011 Sep 23.
To determine whether safety net and non-safety net hospitals influence inpatient breast cancer care in insured and uninsured women and in white and African American women.
Six years of Virginia Cancer Registry and Virginia Health Information discharge data were linked and supplemented with American Hospital Association data.
Hierarchical generalized linear models and linear probability regression models were used to estimate the relationship between hospital safety net status, the explanatory variables, and the days from diagnosis to mastectomy and the likelihood of breast reconstruction.
The time between diagnosis and surgery was longer in safety net hospitals for all patients, regardless of insurance source. Medicaid insured and uninsured women were approximately 20 percent less likely to receive reconstruction than privately insured women. African American women were less likely to receive reconstruction than white women.
Following the implementation of health reform, disparities may potentially worsen if safety net hospitals' burden of care increases without commensurate increases in reimbursement and staffing levels. This study also suggests that Medicaid expansions may not improve outcomes in inpatient breast cancer care within the safety net system.
确定安全网医院和非安全网医院是否会影响保险和非保险女性以及白人和非裔美国女性的住院乳腺癌护理。
弗吉尼亚癌症登记处和弗吉尼亚健康信息出院数据六年的数据进行了关联，并辅以美国医院协会的数据。
使用层次广义线性模型和线性概率回归模型来估计医院安全网状态、解释变量与从诊断到乳房切除术的天数以及乳房重建的可能性之间的关系。
对于所有患者，无论保险来源如何，安全网医院的手术时间都更长。医疗补助保险的参保和未参保女性接受重建的可能性比私人保险女性低约 20%。非裔美国女性接受重建的可能性低于白人女性。
在医疗改革实施后，如果安全网医院的护理负担增加，而报销和人员配备水平没有相应增加，那么差异可能会恶化。本研究还表明，医疗补助扩大可能不会改善安全网系统内住院乳腺癌护理的结果。
