Jha A K, Kuperman G J, Rittenberg E, Bates D W
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA.
J Gen Intern Med. 1998 Jul;13(7):476-81. doi: 10.1046/j.1525-1497.1998.00137.x.
To determine whether gender is associated with the use of ancillary services in hospitalized patients.
A retrospective study of laboratory and radiology tests ordered for medical and surgical inpatients over 16-month and 20-month periods, respectively. Obstetric patients were excluded.
Number of clinical laboratory and radiology tests per admission, their associated charges, and total charges per admission were measured. In crude analyses, women had 16.5% fewer clinical laboratory tests (p < .0001) with 18.8% lower associated charges (p < .0001) and 24.4% fewer radiology tests (p < .0001) with 15.6% lower associated charges (p < .0001) than men. Total changes for the admission were lower for women in both the clinical laboratory study period ($16,178 vs $18,912, p < .0001) and the radiology study period ($14,621 vs $18,182, p < .0001). When adjusted for age, race, insurance status, service, diagnosis-related-group weight, and length of stay, these differences were smaller but persisted: women had 3.7% fewer laboratory tests performed (p < .001) with 4.8% lower associated charges (p < .001). In similarly adjusted analyses for radiology studies, women received 10.4% fewer radiology examinations (p < .001), with 4.1% lower associated charges (p < .01). There were no significant differences in the adjusted total charges in the laboratory group ($17,450 vs $17,655, p = .20) and only a marginally significant difference in the radiology group ($16,278 vs $16,498, p = .05). When we compared ancillary utilization within the five largest diagnosis-related groups, these differences persisted.
Men receive more ancillary services than women, even after adjusting for potential confounders.
确定住院患者使用辅助服务是否与性别有关。
分别对16个月和20个月期间内科和外科住院患者所做的实验室检查和放射检查进行回顾性研究。产科患者被排除在外。
测量每次住院的临床实验室检查和放射检查次数、相关费用以及每次住院的总费用。在粗分析中，女性的临床实验室检查次数比男性少16.5%（p <.0001），相关费用低18.8%（p <.0001）；放射检查次数比男性少24.4%（p <.0001），相关费用低15.6%（p <.0001）。在临床实验室研究期间和放射学研究期间，女性每次住院的总费用均低于男性（分别为16,178美元对18,912美元，p <.0001；14,621美元对18,182美元，p <.0001）。在对年龄、种族、保险状况、服务、诊断相关组权重和住院时间进行调整后，这些差异变小但仍然存在：女性进行的实验室检查次数少3.7%（p <.001），相关费用低4.8%（p <.001）。在对放射学研究进行类似调整的分析中，女性接受的放射学检查少10.4%（p <.001），相关费用低4.1%（p <.01）。实验室组调整后的总费用无显著差异（17,450美元对17,655美元，p =.20），放射学组仅有微小显著差异（16,278美元对16,498美元，p =.05）。当我们比较五个最大诊断相关组内的辅助服务利用率时，这些差异仍然存在。
即使在对潜在混杂因素进行调整后，男性接受的辅助服务仍比女性多。
