Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland, USA.
Health Serv Res. 2022 Oct;57(5):1006-1019. doi: 10.1111/1475-6773.14010. Epub 2022 Jun 7.
To characterize the quantity and quality of hospital capacity across the United States.
We combine a 2017 near-census of US hospital inpatient discharges from the Healthcare Cost and Utilization Project (HCUP) with American Hospital Association Survey, Hospital Compare, and American Community Survey data.
This study produces local hospital capacity quantity and care quality measures by allocating capacity to zip codes using market shares and population totals. Disparities in these measures are examined by race and ethnicity, income, age, and urbanicity.
DATA COLLECTION/EXTRACTION METHODS: All data are derived from pre-existing sources. All hospitals and zip codes in states, including the District of Columbia, contributing complete data to HCUP in 2017 are included.
Non-Hispanic Black individuals living in zip codes supplied, on average, 0.11 more beds per 1000 population (SE = 0.01) than places where non-Hispanic White individuals live. However, the hospitals supplying this capacity have 0.36 fewer staff per bed (SE = 0.03) and perform worse on many care quality measures. Zip codes in the most urban parts of America have the least hospital capacity (2.11 beds per 1000 persons; SEM = 0.01) from across the rural-urban continuum. While more rural areas have markedly higher capacity levels, urban areas have advantages in staff and capital per bed. We do not find systematic differences in care quality between rural and urban areas.
This study highlights the importance of lower hospital care quality and resource intensity in driving racial and ethnic, as well as income, disparities in hospital care-related outcomes. This study also contributes an alternative approach for measuring local hospital capacity that accounts for cross-hospital service area flows. Adjusting for these flows is necessary to avoid underestimating the supply of capacity in rural areas and overestimating it in places where non-Hispanic Black individuals tend to live.
描述美国医院能力的数量和质量。
我们将 2017 年美国医疗保健成本和利用项目（HCUP）的近普查中医院住院患者出院数据与美国医院协会调查、医院比较和美国社区调查数据相结合。
本研究通过使用市场份额和人口总数将能力分配到邮政编码，从而生成当地医院能力数量和护理质量指标。通过种族和民族、收入、年龄和城市化程度来检查这些指标的差异。
数据收集/提取方法：所有数据均来自现有来源。包括哥伦比亚特区在内的所有州的所有医院和邮政编码，如果在 2017 年向 HCUP 提供完整数据，则包括在内。
居住在非西班牙裔黑人平均每 1000 人提供 0.11 个床位（SE=0.01）的邮政编码的人比居住在非西班牙裔白人的地方多。然而，提供这种能力的医院每床（SE=0.03）的员工人数少 0.36 人，在许多护理质量指标上表现更差。美国最城市化地区的邮政编码（每 1000 人 2.11 张床位；SEM=0.01）的医院能力最低。虽然农村地区的医院能力水平明显较高，但城市地区在每床员工和资本方面具有优势。我们没有发现农村和城市地区之间护理质量存在系统差异。
本研究强调了较低的医院护理质量和资源强度对推动与医院护理相关结果的种族和民族以及收入差异的重要性。本研究还提供了一种替代方法来衡量当地医院能力，该方法考虑了跨医院服务区域的流量。调整这些流量对于避免低估农村地区的能力供应和高估非西班牙裔黑人居住的地方的能力供应是必要的。
