Mongan Institute for Health Policy, Massachusetts General Hospital, 50 Staniford St., Ninth Floor, Boston, MA 02114, USA.
Health Serv Res. 2013 Feb;48(1):114-28. doi: 10.1111/j.1475-6773.2012.01445.x. Epub 2012 Jul 20.
Hospital care for blacks is concentrated among a small number of hospitals and whether they have worse outcomes across common medical conditions is unknown.
We used the 2007 100% Medicare file to calculate 30- and 90-day mortality rates for white and black patients admitted for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia.
We ranked all hospitals in the country by their proportion of discharged black patients and identified the top 10 percent of these hospitals as black serving. We examined race-specific adjusted mortality rates and adjusted for differences in hospital characteristics.
At 30 days, black-serving hospitals had, compared with nonblack-serving hospitals, similar mortality for AMI, lower mortality for CHF, and higher mortality for pneumonia. At 90 days, mortality was higher at black-serving hospitals for both AMI and pneumonia and comparable for CHF compared with nonblack-serving hospitals. White patients had worse outcomes at black-serving hospitals for two conditions at 30 days and all three conditions at 90 days. Blacks also had worse outcomes at black-serving hospitals.
Hospitals with a high proportion of black patients had worse outcomes than other hospitals for both their white and black elderly patients.
黑人患者的住院治疗主要集中在少数几家医院，而这些医院在常见医疗条件下的治疗效果是否更差尚不清楚。
我们使用了 2007 年 Medicare 100%的档案，计算了白人患者和黑人患者因急性心肌梗死（AMI）、充血性心力衰竭（CHF）或肺炎入院后 30 天和 90 天的死亡率。
我们按出院黑人患者比例对全国所有医院进行排名，并将这些医院中排名前 10%的医院确定为黑人服务医院。我们检查了特定种族的调整死亡率，并调整了医院特征的差异。
在 30 天内，与非黑人服务医院相比，黑人服务医院的 AMI 死亡率相似，CHF 死亡率较低，肺炎死亡率较高。90 天时，黑人服务医院的 AMI 和肺炎死亡率较高，CHF 死亡率与非黑人服务医院相当。对于两种情况，白人患者在黑人服务医院的 30 天和所有三种情况的 90 天的死亡率均高于非黑人服务医院。黑人患者在黑人服务医院的死亡率也更高。
高比例黑人患者的医院在白人患者和黑人老年患者的治疗效果方面均逊于其他医院。
