Gaskin Darrell J, Zare Hossein, Haider Adil H, LaVeist Thomas A
Department of Health Policy and Management, Hopkins Center of Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Health Serv Res. 2016 Jun;51(3):910-36. doi: 10.1111/1475-6773.12394. Epub 2015 Sep 29.
To explore the association between quality of care for surgical and pneumonia patients and the racial/ethnic composition of hospitals' patients.
Our primary data were surgical and pneumonia processes of care indicators from the 2012 Medicare Hospital Compare Data. We merged this data with information from the 2011 American Hospital Association Annual Survey of Hospitals. We computed the racial and ethnic composition of hospital patients using 2008 data from the Healthcare Costs and Utilization Project.
The sample included 1,198 acute care general hospitals from 11 states: AZ, CA, FL, IA, MA, MD, NC, NJ, NY, WA, and WI. We compared quality across minority-serving, racially integrated, and majority-white hospitals using unconditional quantile regression models controlling for hospital and market characteristics.
We found quality differences between the lowest performing minority-serving, racially integrated, and majority-white hospitals. As we moved from 10th to 90th quantile, the quality differences between hospitals by patients' racial composition disappeared. In other words, the best minority-serving and racially integrated hospitals performed as well as the best majority hospitals.
Efforts to improve quality of care for patients in minority-serving and racially integrated hospitals should focus on the lowest performers.
探讨外科手术患者和肺炎患者的护理质量与医院患者种族/民族构成之间的关联。
我们的主要数据来自2012年医疗保险医院比较数据中的外科手术和肺炎护理流程指标。我们将这些数据与2011年美国医院协会医院年度调查的信息进行了合并。我们使用医疗成本和利用项目2008年的数据计算了医院患者的种族和民族构成。
样本包括来自11个州的1198家急性护理综合医院：亚利桑那州、加利福尼亚州、佛罗里达州、爱荷华州、马萨诸塞州、马里兰州、北卡罗来纳州、新泽西州、纽约州、华盛顿州和威斯康星州。我们使用无条件分位数回归模型，在控制医院和市场特征的情况下，比较了为少数族裔服务的医院、种族融合的医院和以白人为主的医院的护理质量。
我们发现，表现最差的为少数族裔服务的医院、种族融合的医院和以白人为主的医院之间存在质量差异。当我们从第10百分位数移至第90百分位数时，按患者种族构成划分的医院之间的质量差异消失了。换句话说，最好的为少数族裔服务的医院和种族融合的医院与最好的以白人为主的医院表现相当。
提高为少数族裔服务的医院和种族融合的医院患者护理质量的努力应集中在表现最差的医院。
