Department of Health Policy & Management, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC 27599, USA.
Health Serv Res. 2012 Jun;47(3 Pt 1):1158-78. doi: 10.1111/j.1475-6773.2011.01363.x. Epub 2011 Dec 15.
To determine the degree to which racial and ethnic disparities in the use of postacute rehabilitation care (PARC) are explained by observed characteristics.
State inpatient databases (SIDs) for 2005 and 2006 from four diverse states were used to identify patients with stays for joint replacement, stroke, or hip fracture.
Our primary outcomes were use of institutional PARC (versus discharge home) and, conditional on discharge to an institution, skilled nursing facility (versus inpatient rehabilitation facility) care. We modified the Oaxaca-Blinder decomposition method to account for the dichotomous outcome and multilevel nature of the data.
DATA COLLECTION/EXTRACTION METHODS: Discharges from the four SIDs were included if the principal diagnosis (stroke, hip fracture) or procedure (joint replacement) was in the sample inclusion criteria.
Observed characteristics explained roughly half of the unadjusted differences in use of institutional PARC. Patient-level factors (clinical, age) were more explanatory of disparities in institutional PARC use, while hospital-level factors were more explanatory of skilled nursing facility versus inpatient rehabilitation facility care.
Adjustment for characteristics influencing PARC use both mitigated and exacerbated racial/ethnic disparities in use. The degree to which the characteristics explained the disparity varied across conditions and outcomes.
确定观察到的特征在多大程度上解释了急性后期康复治疗（PARC）利用方面的种族和民族差异。
使用来自四个不同州的 2005 年和 2006 年的州住院数据库（SID），以确定接受关节置换、中风或髋部骨折治疗的患者。
我们的主要结果是利用机构 PARC（而非出院回家），以及在出院到机构的情况下，利用熟练护理设施（而非住院康复设施）进行护理。我们修改了 Oaxaca-Blinder 分解方法，以考虑到二分结果和数据的多层次性质。
数据收集/提取方法：如果主要诊断（中风、髋部骨折）或手术（关节置换）在样本纳入标准内，则将来自四个 SID 的出院纳入研究。
观察到的特征解释了未经调整的机构 PARC 利用差异的大约一半。患者层面的因素（临床、年龄）对机构 PARC 利用差异的解释性更强，而医院层面的因素对熟练护理设施与住院康复设施护理的差异的解释性更强。
对影响 PARC 使用的特征进行调整，既减轻了也加剧了种族/民族在 PARC 使用方面的差异。这些特征在多大程度上解释了差异因条件和结果而异。
