José F. Figueroa (
Laura G. Burke is an assistant professor of emergency medicine in the Department of Emergency Medicine, Harvard Medical School.
Health Aff (Millwood). 2020 Jun;39(6):1065-1071. doi: 10.1377/hlthaff.2019.01019.
Racial disparities in hospitalization rates for ambulatory care-sensitive conditions are concerning and may signal differential access to high-quality ambulatory care. Whether racial disparities are improving as a result of better ambulatory care versus artificially narrowing because of increased use of observation status is unclear. Using Medicare data for 2011-15, we sought to determine whether black-white disparities in avoidable hospitalizations were improving and evaluated the degree to which changes in observations for ambulatory care-sensitive conditions may be contributing to changes in these gaps. We found that while the racial gap in avoidable hospitalizations due to such conditions has decreased, that seems to be explained by a concomitant increase in the gap of avoidable observation stays. This suggests that changes from inpatient admissions to observation status seem to be driving the reduction in racial disparities in avoidable hospitalizations, rather than changes in the ambulatory setting.
门诊治疗敏感病症的住院率存在种族差异，这令人担忧，可能表明获得高质量门诊治疗的机会存在差异。由于观察状态的使用增加而人为缩小，而不是由于更好的门诊治疗而导致种族差异得到改善，这种情况尚不清楚。利用 2011 年至 2015 年的 Medicare 数据，我们试图确定可避免住院治疗的黑人和白人之间的差异是否在改善，并评估观察到的门诊治疗敏感病症的变化在多大程度上导致了这些差距的变化。我们发现，虽然由于这些病症导致的可避免住院治疗的种族差距有所缩小，但这似乎是由于可避免观察停留的差距同时增加所致。这表明，从住院入院到观察状态的变化似乎是导致可避免住院治疗种族差异减少的原因，而不是门诊环境的变化。
