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: 8449590
• 负责人: ASHISH K JHA
• 金额: $ 38.16万
• 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/8449590
• 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; abstracting; 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

Project Abstract 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.

项目摘要 了解健康差异的根本原因，并开发有效的方法来促进 公平健康成果是关键的健康政策目标。虽然我们有大量数据显示了很大的差距 少数民族和非少数族裔患者之间的护理，我们在消除这些差距方面几乎没有取得进展。 先前的研究表明，最佳的患者经验可以改善健康状况和健康 身份，少数族裔患者报告的门诊护理经验比白人患者更糟糕。但是，我们 在医院环境中患者经历中潜在的种族和种族差异的数据有限 可能解释这些差距的因素。新的国家政策努力，旨在奖励或处罚医院 根据他们在患者体验指标上的表现，需要了解医院是否是否 对少数族裔的不成比例关心的表现较差，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，以更好地理解医院差异 患者的经验，并为干预措施提供至关重要的数据，以促进公平护理。 我们建议使用有关HCAHPS数据库医院护理患者经验的患者级数据 检查四个目标。首先，我们检查整体上的种族或种族差异。我们 然后检查经验差异在“医院差异”之间引起的程度 医院差异，或两者兼而有之。我们的第二个目标是检查解释或修改内部差异的因素 医院。第三，我们将检查医院中少数族裔患者的比例是否与医院有关 对患者体验指标的表现，以及领导者对患者经验的承诺是否 财务健康和护士人员配备水平解释了少数族裔与患者比例之间的关系 经验。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。 我们的作品将描绘出美国医院中黑人，西班牙裔和白人美国人的经历的国家肖像 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 在老年人或医院中，经验的差异最为明显 少数族裔患者，这些发现将为干预提供目标。对机构调解员的分析 应该提供有关哪些干预措施最有效地减少患者差异的有用指导 经验。最后，我们对少数族裔服务医院如何随着时间的改善将提供关键的纵向分析 关于在何处促进所有美国人促进公平，以患者为中心的护理的见解。