Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine.
Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine.
Ann Am Thorac Soc. 2022 Dec;19(12):2044-2052. doi: 10.1513/AnnalsATS.202202-115OC.
Patients who identify as from racial or ethnic minority groups who have sepsis or acute respiratory failure (ARF) experience worse outcomes relative to nonminority patients, but processes of care accounting for disparities are not well-characterized. Determine whether reductions in intensive care unit (ICU) admission during hospital-wide capacity strain occur preferentially among patients who identify with racial or ethnic minority groups. This retrospective cohort among 27 hospitals across the Philadelphia metropolitan area and Northern California between 2013 and 2018 included adult patients with sepsis and/or ARF who did not require life support at the time of hospital admission. An updated model of hospital-wide capacity strain was developed that permitted determination of relationships between patient race, ethnicity, ICU admission, and strain. After adjustment for demographics, disease severity, and study hospital, patients who identified as Asian or Pacific Islander had the highest adjusted ICU admission odds relative to patients who identified as White in both the sepsis and ARF populations (odds ratio, 1.09; = 0.006 and 1.26; < 0.001). ICU admission was also elevated for patients with ARF who identified as Hispanic (odds ratio, 1.11; = 0.020). Capacity strain did not modify differences in ICU admission for patients who identified with a minority group in either disease population (all interactions, > 0.05). Systematic differences in ICU admission patterns were observed for patients that identified as Asian, Pacific Islander, and Hispanic. However, ICU admission was not restricted from these groups, and capacity strain did not preferentially reduce ICU admission from patients identifying with minority groups. Further characterization of provider decision-making can help contextualize these findings as the result of disparate decision-making or a mechanism of equitable care.
患有败血症或急性呼吸衰竭 (ARF) 的自认为属于少数族裔的患者与非少数族裔患者相比，预后更差，但导致差异的护理过程尚不清楚。确定在全院容量紧张期间，是否优先减少入住重症监护病房 (ICU) 的患者是自认为属于少数族裔的患者。这项回顾性队列研究在 2013 年至 2018 年间在费城大都市区和北加利福尼亚的 27 家医院进行，纳入了患有败血症和/或 ARF 的成年患者，他们在入院时不需要生命支持。开发了一种更新的全院容量紧张模型，该模型允许确定患者种族、族裔、ICU 入院和紧张之间的关系。在校正人口统计学、疾病严重程度和研究医院后，与自认为是白人的患者相比，自认为是亚洲或太平洋岛民的患者在败血症和 ARF 人群中 ICU 入院的调整后几率最高（比值比，1.09；=0.006 和 1.26；<0.001）。自认为是西班牙裔的 ARF 患者 ICU 入院的几率也较高（比值比，1.11；=0.020）。在这两种疾病人群中，容量紧张并未改变自认为属于少数族裔的患者 ICU 入院差异（所有交互作用，>0.05）。对于自认为是亚洲、太平洋岛民和西班牙裔的患者，观察到 ICU 入院模式存在系统差异。然而，这些群体并未被限制入住 ICU，容量紧张也没有优先减少来自少数民族群体的患者入住 ICU。进一步描述提供者的决策制定过程可以帮助将这些发现解释为不同决策的结果或公平护理的机制。
