RAND Corporation, Arlington, Virginia, USA.
RAND Corporation, Santa Monica, California, USA.
Health Serv Res. 2022 Dec;57 Suppl 2(Suppl 2):279-290. doi: 10.1111/1475-6773.14028. Epub 2022 Jul 25.
To identify the association between strained intensive care unit (ICU) capacity during the COVID-19 pandemic and hospital racial and ethnic patient composition, federal pandemic relief, and other hospital characteristics.
We used government data on hospital capacity during the pandemic and Provider Relief Fund (PRF) allocations, Medicare claims and enrollment data, hospital cost reports, and Social Vulnerability Index data.
We conducted cross-sectional bivariate analyses relating strained capacity and PRF award per hospital bed with hospital patient composition and other characteristics, with and without adjustment for hospital referral region (HRR).
We linked PRF data to CMS Certification Numbers based on hospital name and location. We used measures of racial and ethnic composition generated from Medicare claims and enrollment data. Our sample period includes the weeks of September 18, 2020 through November 5, 2021, and we restricted our analysis to short-term, general hospitals with at least one intensive care unit (ICU) bed. We defined "ICU strain share" as the proportion of ICU days occurring while a given hospital had an ICU occupancy rate ≥ 90%.
After adjusting for HRR, hospitals in the top tercile of Black patient shares had higher ICU strain shares than did hospitals in the bottom tercile (30% vs. 22%, p < 0.05) and received greater PRF amounts per bed ($118,864 vs. $92,407, p < 0.05). Having high versus low ICU occupancy relative to pre-pandemic capacity was associated with a modest increase in PRF amounts per bed after adjusting for HRR ($107,319 vs. $96,627, p < 0.05), but there were no statistically significant differences when comparing hospitals with high versus low ICU occupancy relative to contemporaneous capacity.
Hospitals with large Black patient shares experienced greater strain during the pandemic. Although these hospitals received more federal relief, funding was not targeted overall toward hospitals with high ICU occupancy rates.
确定在 COVID-19 大流行期间，重症监护病房（ICU）紧张程度与医院的种族和民族患者构成、联邦大流行救济金以及其他医院特征之间的关联。
我们使用了有关医院在大流行期间的能力以及提供者救济基金（PRF）拨款、医疗保险索赔和登记数据、医院成本报告和社会脆弱性指数数据的政府数据。
我们进行了横断面双变量分析，将紧张的容量和每床 PRF 奖励与医院患者构成和其他特征相关联，包括和不包括对医院转诊区域（HRR）的调整。
我们根据医院名称和位置将 PRF 数据链接到 CMS 认证号码。我们使用从医疗保险索赔和登记数据中生成的种族和民族构成的度量标准。我们的样本期包括 2020 年 9 月 18 日至 2021 年 11 月 5 日这几周，并且我们将分析仅限于短期、至少有一个 ICU 床位的综合医院。我们将“ICU 紧张份额”定义为 ICU 入住率≥90%时发生的 ICU 天数所占比例。
在调整 HRR 后，黑病人比例最高的医院 ICU 紧张份额高于黑病人比例最低的医院（30%比 22%，p<0.05），并且每床获得的 PRF 金额更高（$118,864 比$92,407，p<0.05）。相对于大流行前的容量，ICU 入住率相对于高与低，在调整 HRR 后，每床 PRF 金额略有增加（$107,319 比$96,627，p<0.05），但与同期容量相比，ICU 入住率高与低的医院之间没有统计学上的显著差异。
黑人患者比例较高的医院在大流行期间经历了更大的压力。尽管这些医院获得了更多的联邦救济金，但总体而言，资金并未针对 ICU 入住率高的医院。
