Spencer Christine S, Roberts Eric T, Gaskin Darrell J
*College of Public Affairs, University of Baltimore †Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Med Care. 2015 Jun;53(6):524-9. doi: 10.1097/MLR.0000000000000363.
The reduction of adverse patient safety events and the equitable treatment of patients in hospitals are clinical and policy priorities. Health services researchers have identified disparities in the quality of care provided to patients, both by demographic characteristics and insurance status. However, less is known about the extent to which disparities reflect differences in the places where patients obtain care, versus disparities in the quality of care provided to different groups of patients in the same hospital.
In this study, we examine whether the rate of adverse patient safety events differs by the insurance status of patients within the same hospital.
Using discharge data from hospitals in 11 states, we compared risk-adjusted rates for 13 AHRQ Patient Safety Indicators by Medicare, Medicaid, and Private payer insurance status, within the same hospitals. We used multivariate regression to assess the relationship between insurance status and rates of adverse patient safety events within hospitals.
Medicare and Medicaid patients experienced significantly more adverse safety events than private pay patients for 12 and 7 Patient Safety Indicators, respectively (at P < 0.05 or better). However, Medicaid patients had significantly lower event rates than private payers on 2 Patient Safety Indicators.
Risk-adjusted Patient Safety Indicator rates varied with patients' insurance within the same hospital. More research is needed to determine the cause of differences in care quality received by patients at the same hospital, especially if quality measures are to be used for payment.
减少患者安全不良事件以及在医院中公平对待患者是临床和政策的重点。卫生服务研究人员已经发现，根据人口统计学特征和保险状况，患者接受的护理质量存在差异。然而，对于这种差异在多大程度上反映了患者接受护理的地点不同， versus 同一医院内不同患者群体接受的护理质量差异，我们了解得较少。
在本研究中，我们调查了同一医院内患者的保险状况是否会导致患者安全不良事件发生率的差异。
我们使用了11个州医院的出院数据，比较了同一医院内医疗保险、医疗补助和私人付费保险状况下13项美国医疗保健研究与质量局（AHRQ）患者安全指标的风险调整率。我们使用多元回归分析来评估保险状况与医院内患者安全不良事件发生率之间的关系。
在12项和7项患者安全指标上，医疗保险患者和医疗补助患者分别比私人付费患者经历了显著更多的不良安全事件（P < 0.05或更低）。然而，在2项患者安全指标上，医疗补助患者的事件发生率显著低于私人付费患者。
在同一医院内，经风险调整后的患者安全指标率因患者的保险情况而异。需要进行更多研究以确定同一医院内患者接受不同护理质量的原因，特别是如果质量指标要用于支付的话。
