School of Medicine, University of California, San Diego, San Diego, CA, USA.
Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA.
J Clin Anesth. 2019 May;54:66-71. doi: 10.1016/j.jclinane.2018.10.036. Epub 2018 Nov 5.
Safety-net hospitals disproportionately care for high-risk patients. Prior work has shown safety-net hospitals to have inferior postoperative outcomes with higher cost and worse patient ratings. We aim to examine the association of hospital safety-net burden with morbidity and mortality in patients with opioid overdose hospital admission.
Retrospective cross-sectional analysis using the National Inpatient Sample registry from 2010 to 2014.
Multi-institutional.
We included 547, 399 patients admitted to a United States hospital with an International Classification of Disease, Ninth Revision, code of opioid overdose. To study the association of hospital safety-net burden on mortality and morbidity, we calculated hospital safety-net burden defined as the percent of Medicaid or uninsured among all admitted patients. Hospitals were categorized into one of three categories: low burden hospitals, medium burden hospitals, and high burden hospitals (i.e., safety-net hospitals). We performed a mixed effects multivariable logistic regression analysis to assess the association of hospital safety-net burden with short-term inpatient outcomes.
None.
The primary outcomes were inpatient mortality and morbidity.
Compared to MBHs and LBHs, HBHs had a greater proportion of minority patients (i.e., Black, Hispanic, and Native American) and patients with median household income in the lowest quartile (p < 0.001). Among prescription opioid overdose admissions, the odds of inpatient mortality and pulmonary and cardiac morbidity were also not significantly higher between HBHs versus LBHs (p > 0.05).
Safety-net hospital disproportionately care for vulnerable populations, however the odds of poor outcomes were no different in opioid overdose. Safety-net hospitals should have equal access to the funding and resources that allows them to deliver the same standard of care as their counterparts.
安全网医院对高风险患者的照顾比例过高。先前的研究表明，安全网医院的术后结果较差，成本较高，患者评价较差。我们旨在研究医院安全网负担与阿片类药物过量住院患者发病率和死亡率之间的关系。
使用 2010 年至 2014 年国家住院患者样本登记处进行回顾性横断面分析。
多机构。
我们纳入了 547399 名在美国因阿片类药物过量而住院的患者，这些患者的国际疾病分类第 9 修订版（ICD-9）代码为阿片类药物过量。为了研究医院安全网负担对死亡率和发病率的影响，我们计算了医院安全网负担，定义为所有入院患者中医疗补助或无保险患者的比例。医院分为三类：低负担医院、中负担医院和高负担医院（即安全网医院）。我们进行了混合效应多变量逻辑回归分析，以评估医院安全网负担与短期住院结果之间的关系。
无。
主要结果是住院死亡率和发病率。
与 MBH 和 LBH 相比，HBH 有更大比例的少数民族患者（即黑人和西班牙裔以及美国原住民）和收入处于最低四分位数的患者（p<0.001）。在处方阿片类药物过量入院的患者中，HBH 与 LBH 相比，住院死亡率和心肺发病率的几率也没有显著更高（p>0.05）。
安全网医院不成比例地照顾弱势群体，然而，在阿片类药物过量的情况下，不良结果的几率并没有不同。安全网医院应该平等获得资金和资源，使他们能够提供与同行相同的护理标准。
