城市研究所-黑人和白人患者在同一家医院的不良安全事件发生率相似吗?(英)-2021.7-35正式版.ppt
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1、HEALTH POLICY CENTERRESEARCH REPORTDo Black and White PatientsExperience Similar Rates of AdverseSafety Events at the Same Hospital?Anuj GangopadhyayaJuly 2021ABOUT THE URBAN INSTITUTEThe nonprofit Urban Institute is a leading research organization dedicated to developing evidence-based insightsthat
2、 improve peoples lives and strengthen communities.For 50 years,Urban has been the trusted source forrigorous analysis of complex social and economic issues;strategic advice to policymakers,philanthropists,andpractitioners;and new,promising ideas that expand opportunities for all.Our work inspires ef
3、fective decisionsthat advance fairness and enhance the well-being of people and places.Copyright July 2021.Urban Institute.Permission is granted for reproduction of this file,with attribution to theUrban Institute.Cover image by Tim Meko.ContentsAcknowledgmentsivDo Black and White Patients Experienc
4、e Similar Rates of Adverse Safety Events at theSame Hospital?123577Key FindingsBackgroundData and MethodsResultsDo Black and White Patients Experience Different Patient Safety in the Same Hospital?Do Differences in Insurance Coverage and Type Contribute to Black-White Differences inPatient Safety?11
5、Do Black-White Differences in Patient Safety Differ in Hospitals That Care for Larger Shares ofBlack Patients or in Hospitals with Greater Financial Resources?15Discussion202425272930Appendix:Supplemental TableNotesReferencesAbout the AuthorStatement of IndependenceAcknowledgmentsThis report was fun
6、ded by the Robert Wood Johnson Foundation.We are grateful to them and to allour funders,who make it possible for Urban to advance its mission.The views expressed are those of the author and should not be attributed to the Urban Institute,its trustees,or its funders.Funders do not determine research
7、findings or the insights andrecommendations of Urban experts.Further information on the Urban Institutes funding principles isavailable at urban.org/fundingprinciples.This report greatly benefited from feedback from Dulce Gonzalez,Genevieve M.Kenney,FaithMitchell,Kim Taylor,Tim Waidmann,and Stephen
8、Zuckerman,as well as from the comments,suggestions and questions that resulted from discussions with members of a community advisory boardorganized and overseen by Myriam Hernandez-Jennings of Community Catalyst and Kim Taylor of theUrban Institute.This report also benefited from the editorial assis
9、tance of David Hinson,DevlanOConnor,and Michael Marazzi.ivACKNOWLEDGMENTSDo Black and White PatientsExperience Similar Rates of AdverseSafety Events at the Same Hospital?Patient safety is“freedom from accidental injury due to medical care or medical errors”(IOM 2000)and represents a fundamental doma
10、in of inpatient quality of care.Hospital-acquired illnesses andinjuries have direct consequences on patient health and erode the trust patients place in providers andhealth systems.Our recent Urban Institute analysis found that in the 26 states with available data for2017,Black adult patients experi
11、enced higher rates of hospital-acquired injuries or illnesses than whitepatients and that some of these differences in patient safety can be attributed to differences in thequality of hospitals that Black patients are admitted to relative to white patients(Gangopadhyaya2021).A related but unresolved
12、 research question is whether Black and white patients experiencesimilar rates of adverse patient safety events when admitted to the same hospital.Investigatingwithin-hospital racial differences in patient safety is critical to understanding what progress,if any,hasbeen made in improving racial equi
13、ty in health care.Moreover,policies intended to remedy racialinequities in the quality of the hospitals patients are admitted to,discussed in Gangopadhyaya(2021),could be ineffective if racial differences in patient safety risks persist even when patients are admittedto the same hospital.Examining w
14、ithin-hospital differences in Black and white adult patient safety risks is the centralfocus of this study.We assess racial disparities in the quality of inpatient care using 11 patient safetyindicators that measure rates of adverse patient safety events of hospital-acquired illnesses or injuries.Fo
15、ur of these measures center on general patient safety,and seven center on adverse eventssurrounding surgical procedures.This study investigates differences in Black and white patient safetyusing hospital discharge records from 26 states in 2017 and examines whether these differencesnarrow when compa
16、ring Black and white patients within the same hospital.We further assess whetherthese within-hospital differences in Black and white patient safety indicators persist when comparingpatients with similar types of insurance coverage.Finally,we investigate whether inequities in patientsafety by race di
17、ffer in hospitals that serve more Black patients or more private paying patients as ashare of all patients.Key FindingsFor 6 out of 11 patient safety indicators,including 4 out of 7 surgery-related patient safetyindicators,Black adult patients experienced significantly worse patient safety relative
18、to whitepatients in the same age group,of the same gender,and treated in the same hospital.Whitepatients experienced significantly worse quality of care relative to Black patients in the samehospital on 2 patient safety indicators.When admitted to the same hospital,quality of carewas similar for Bla
19、ck and white patients on 3 out of 11 patient safety indicators.Adjusting for patient insurance coverage type had little effect on the estimated differences inpatient safety risks between Black and white adult patients admitted to the same hospital.Similarly,analyses limiting patient populations to M
20、edicare-covered patients only(the mostfrequent payer for inpatient services)found similar results as the main analysis.Combined,thisevidence suggests that for Black and white patients treated in the same hospital,Black-whitepatient safety disparities persist even when patients have similar types of
21、coverage.When separating hospitals into those in which more than 25 percent of patients are Black andall other hospitals,we find that Black adult patients experienced higher within-hospitaladverse patient safety events relative to white patients in both groups of hospitals.Of the sixpatient safety i
22、ndicators for which Black patients have significantly higher(worse)ratesrelative to white patients in the same hospital overall,five of these differences remainsignificant when comparing Black and white patients treated in the same hospitals in whichmore than 25 percent of patients are Black.Among t
23、he four general patient safety measures,we find mixed evidence that Black adult patientsexperience higher rates of adverse patient safety events relative to white patients when receiving careat the same hospital.But our evidence shows that Black patients systematically experience higherrates of hosp
24、ital-acquired illnesses or injuries related to surgical procedures relative to white patientstreated in the same hospital.For all seven of these surgery-related measures,rates of adverse patientsafety events were higher for Black patients relative to white patients.For four of the seven measures,the
25、se differences were clinically large and statistically significant.For example,per 1,000 at-riskdischarges(discharges at risk for experiencing a specific adverse event based on diagnostic andprocedural codes),Black patients had rates of postoperative sepsis infections that were 1.3 caseshigher than
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