Oddleifson D August, Xu Xiao, Wiznia Daniel, Gibson David, Spatz Erica S, Desai Nihar R
From the Yale University School of Medicine, New Haven, CT.
J Am Acad Orthop Surg. 2023 Nov 1;31(21):e961-e973. doi: 10.5435/JAAOS-D-23-00183. Epub 2023 Aug 3.
This study aimed to determine whether healthcare markets with higher social vulnerability have lower access to high-quality hip and knee replacement hospitals and whether hospitals that serve a higher percentage of low-income patients are less likely to be designated as high-quality.
This cross-sectional study used 2021 Centers for Medicare and Medicaid Services outcome measures and 2022 Joint Commission (JC) process-of-care measures to identify hospitals performing high-quality hip and knee replacement. A total of 2,682 hospitals and 304 healthcare markets were included. For the market-level analysis, we assessed the association of social vulnerability with the presence of a high-quality hip and knee replacement center. For the hospital-level analysis, we assessed the association of disproportionate share hospital (DSH) percentage with each high-quality designation. Healthcare markets were approximated by hospital referral regions. All associations were assessed with fractional regressions using generalized linear models with binomial family and logit links.
We found that healthcare markets in the most vulnerable quartile were less likely to have a hip and knee replacement hospital that did better than the national average (odds ratio [OR] 0.22, P = 0.02) but not more or less likely to have a hospital certified as advanced by JC (OR 0.41, P = 0.16). We found that hip and knee replacement hospitals in the highest DSH quartile were less likely to be designated by the Centers for Medicare and Medicaid Services as better than the national average (OR 0.18, P = 0.001) but not more or less likely to be certified as advanced by JC (OR 1.40, P = 0.28).
Geographic distribution of high-quality hospitals may contribute to socioeconomic disparities in patients' access to and utilization of high-quality hip and knee replacement. Equal access to and utilization of hospitals with high-quality surgical processes does not necessarily indicate equitable access to and utilization of hospitals with high-quality outcomes.
Level III.
本研究旨在确定社会脆弱性较高的医疗市场获得高质量髋关节和膝关节置换医院的机会是否较低，以及服务低收入患者比例较高的医院被指定为高质量医院的可能性是否较小。
这项横断面研究使用了2021年医疗保险和医疗补助服务中心的结果指标以及2022年联合委员会（JC）的护理过程指标，以识别进行高质量髋关节和膝关节置换的医院。共纳入了2682家医院和304个医疗市场。对于市场层面的分析，我们评估了社会脆弱性与高质量髋关节和膝关节置换中心的存在之间的关联。对于医院层面的分析，我们评估了不成比例份额医院（DSH）百分比与每项高质量指定之间的关联。医疗市场通过医院转诊区域进行近似。所有关联均使用具有二项式族和对数链接的广义线性模型通过分数回归进行评估。
我们发现，处于最脆弱四分位数的医疗市场拥有比全国平均水平表现更好的髋关节和膝关节置换医院的可能性较小（优势比[OR]为0.22，P = 0.02），但拥有经JC认证为先进的医院的可能性并无增减（OR为0.41，P = 0.16）。我们发现，处于DSH最高四分位数的髋关节和膝关节置换医院被医疗保险和医疗补助服务中心指定为优于全国平均水平的可能性较小（OR为0.18，P = 0.001），但被JC认证为先进的可能性并无增减（OR为1.40，P = 0.28）。
高质量医院的地理分布可能导致患者在获得和利用高质量髋关节和膝关节置换方面的社会经济差异。平等获得和利用具有高质量手术过程的医院并不一定意味着平等获得和利用具有高质量结果的医院。
三级。
