Witt Whitney P, Coffey Rosanna M, Lopez-Gonzalez Lorena, Barrett Marguerite L, Moore Brian J, Andrews Roxanne M, Washington Raynard E
Maternal and Child Health Research, Truven Health Analytics, Inc., 4819 Emperor Boulevard, Suite 125, Durham, NC 27703.
Federal Government, Truven Health Analytics, Inc., Bethesda, MD.
Health Serv Res. 2017 Feb;52(1):220-243. doi: 10.1111/1475-6773.12475. Epub 2016 Mar 9.
To examine the role of patient, hospital, and community characteristics on racial and ethnic disparities in in-hospital postsurgical complications.
Healthcare Cost and Utilization Project, 2011 State Inpatient Databases; American Hospital Association Annual Survey of Hospitals; Area Health Resources Files; Centers for Medicare & Medicaid Services Hospital Compare database.
Nonlinear hierarchical modeling was conducted to examine the odds of patients experiencing any in-hospital postsurgical complication, as defined by Agency for Healthcare Research and Quality Patient Safety Indicators.
A total of 5,474,067 inpatient surgical discharges were assessed using multivariable logistic regression. Clinical risk, payer coverage, and community-level characteristics (especially income) completely attenuated the effect of race on the odds of postsurgical complications. Patients without private insurance were 30 to 50 percent more likely to have a complication; patients from low-income communities were nearly 12 percent more likely to experience a complication. Private, not-for-profit hospitals in small metropolitan or micropolitan areas and higher nurse-to-patient ratios led to fewer postsurgical complications.
Race does not appear to be an important determinant of in-hospital postsurgical complications, but insurance and community characteristics have an effect. A population-based approach that includes improving the socioeconomic context may help reduce disparities in these outcomes.
探讨患者、医院及社区特征在住院手术后并发症的种族和民族差异中所起的作用。
2011年医疗成本与利用项目州住院数据库；美国医院协会医院年度调查；区域卫生资源文件；医疗保险和医疗补助服务中心医院比较数据库。
采用非线性分层模型，根据医疗保健研究与质量局患者安全指标，研究患者发生任何住院手术后并发症的几率。
使用多变量逻辑回归对5,474,067例住院手术出院病例进行了评估。临床风险、支付方覆盖范围及社区层面特征（尤其是收入）完全消除了种族对手术后并发症几率的影响。没有私人保险的患者发生并发症的可能性要高出30%至50%；来自低收入社区的患者发生并发症的可能性要高出近12%。在小都市或微型都市地区的私立非营利性医院以及较高的护士与患者比例可减少手术后并发症的发生。
种族似乎并非住院手术后并发症的重要决定因素，但保险和社区特征会产生影响。一种包括改善社会经济环境的基于人群的方法可能有助于减少这些结果方面的差异。
