Understanding Disparities in Patient-Centered Hospital Care

了解以患者为中心的医院护理中的差异

• 批准号: 8281927
• 负责人: ASHISH K JHA
• 金额: $ 38.31万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2014-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8281927
• 关键词: Accounting; Adherence; Affect; African American; Age; Ambulatory Care; American; Area; Caring; Clinical; Data; Databases; Education; Elderly; Ensure; Ethnic Origin; Future; Goals; Health; Health Policy; Health Status; Hispanic Americans; Hispanics; Hospitals; Institute of Medicine (U.S.); Institution; Intervention; Leadership; Mediator of activation protein; Methods; Metric; Minority; Minority Groups; Not Hispanic or Latino; Nursing Staff; Outcome; Paint; Patient Outcomes Assessments; Patient-Centered Care; Patients; Pattern; Performance; Play; Policies; Portraits; Process; Quality of Care; Race; Recommendation; Reporting; Rewards; Role; Site; Subgroup; Time; United States Centers for Medicare and Medicaid Services; Work; base; care delivery; caucasian American; clinical care; ethnic difference; experience; health care quality; health disparity; improved; insight; longitudinal analysis; patient oriented; payment; policy implication; racial and ethnic disparities; racial difference; racial/ethnic difference

DESCRIPTION (provided by applicant): Understanding the underlying causes of health disparities and developing effective methods to promote equitable health outcomes is a critical health policy goal. While we have substantial data showing large gaps in care between minority and non-minority patients, we have made little progress in eliminating these gaps. Previous studies indicate that optimal patient experiences with care may improve health outcomes and health status, and that minority patients report worse experiences with outpatient care than white patients. Yet, we have limited data on potential racial and ethnic disparities in patients' experiences in the hospital setting and factors that might explain these gaps. New national policy efforts, which aim to reward or penalize hospitals based on their performance on metrics of patient experience, create a need to understand whether hospitals that disproportionately care for minorities have worse performance and how we might intervene. Our work will examine both patient and hospital-level factors to better understand within and between hospital differences in patients' experiences and provide critically important data for interventions to promote equitable care. We propose to use patient-level data on patient experiences with hospital care from the HCAHPS database to examine four aims. We begin by examining whether there are racial or ethnic differences in care overall. We then examine the degree to which disparities in experience are due to "within" hospital differences, "between" hospital differences, or both. Our second aim will be to examine factors that explain or modify disparities within hospitals. Third, we will examine if the proportion of minority patients in a hospital is associated with hospital performance on patient experience metrics, and whether leadership's commitment to patient experience, financial health, and nurse staffing levels explain the relationship between proportion of minorities and patient experience. Finally, we will determine the role of these factors in improving patient experience over time. Our work will paint a national portrait of experiences of black, Hispanic, and white Americans in U.S. hospitals and provide timely data to ensure that national policies to improve care do not worsen disparities. We will quantify the degree to which disparities exist and whether they affect certain subgroups more than others. For example, if disparities in experience are most pronounced among the elderly or among hospitals with a large proportion of minority patients, these findings will provide targets for interventions. The analysis on institutional mediators should provide useful guidance about what interventions will most effectively reduce disparities in patient experience. Finally, our longitudinal analysis on how minority-serving hospitals improve over time will provide key insights about where to place future efforts to promote equitable, patient-centered care among all Americans. PUBLIC HEALTH RELEVANCE: Ensuring optimal patient experience, a centerpiece of delivering high quality care, is now an integral part of a major national policy effort to reward hospitals based on performance. Unfortunately, we lack empirical data to help policymakers and clinical leaders improve minorities' experiences and ensure equitable delivery of care. Our study, which aims to determine whether racial and ethnic minorities have worse experiences with hospital care than non-minorities and whether key factors explain racial and ethnic differences in patient experience, will provide important and actionable information to ensure that national policy efforts to improve hospital care promote equity as well as quality.

描述（由申请人提供）：了解健康差异的根本原因，并开发有效的方法来促进公平的健康结果是一个关键的健康政策目标。尽管我们拥有大量数据显示少数族裔和非少数族裔患者之间的护理差距很大，但在消除这些差距方面，我们几乎没有取得进展。先前的研究表明，最佳患者的护理经历可以改善健康状况和健康状况，并且少数族裔患者报告的门诊护理经验比白人患者更糟糕。然而，我们在医院环境中的患者经历以及可能解释这些差距的因素方面的潜在种族和种族差异的数据有限。新的国家政策努力，旨在根据他们对患者经验指标的表现进行奖励或处罚医院，因此需要了解不成比例照顾少数群体的医院是否表现较差，以及我们如何干预。我们的工作将检查患者和医院级别的因素，以更好地理解患者经历的医院差异，并为促进公平护理的干预措施提供至关重要的数据。我们建议使用HCAHPS数据库中医院护理患者经验的患者级数据来检查四个目标。首先，我们检查整体上的种族或种族差异。然后，我们研究经验上的差异是由于“医院差异”，“医院差异”或两者兼有的程度。我们的第二个目标是检查解释或修改医院内差异的因素。第三，我们将检查医院中少数族裔患者的比例是否与医院对患者经验指标的表现有关，以及领导者对患者经验，财务健康和护士人员配备水平的承诺是否解释了少数群体比例与患者经验之间的关系。最后，我们将确定这些因素随着时间的推移改善患者体验的作用。我们的工作将描绘一个国家 美国医院中黑人，西班牙裔和白人美国人的经历的肖像，并提供及时的数据，以确保改善护理的国家政策不会恶化差异。我们将量化存在差异的程度以及它们是否比其他差异更大。例如，如果经验上的差异最明显，在老年人中或大部分少数族裔患者的医院中，这些发现将为干预提供目标。对机构调解人的分析应提供有关哪些干预措施最有效地降低患者体验差异的有用指导。最后，我们对少数族裔服务医院如何随着时间的改善如何改善的纵向分析将提供关键的见解，以了解未来在所有美国人中促进公平，以患者为中心的护理的努力。 公共卫生相关性：确保最佳的患者体验是提供高质量护理的核心，现在是国家政策的重要组成部分，旨在根据绩效奖励医院。不幸的是，我们缺乏经验数据来帮助决策者和临床领导者改善少数群体的经验并确保公平的护理提供。我们的研究旨在确定种族和少数民族在医院护理方面的经验比非少数群体更糟糕，以及关键因素是否可以解释患者经验的种族和种族差异，将提供重要且可行的信息，以确保国家政策改善医院护理的努力促进公平和质量。