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制定有效的方法来促进 公平的健康结果是一项重要的卫生政策目标。虽然我们有大量数据显示存在巨大差距 尽管在少数族裔和非少数族裔患者之间的护理方面，我们在消除这些差距方面进展甚微。 先前的研究表明，最佳的患者护理体验可能会改善健康结果和健康状况 状况，少数族裔患者的门诊护理体验比白人患者差。然而，我们 关于患者在医院环境中的经历中潜在的种族和民族差异的数据有限，并且 可能解释这些差距的因素。旨在奖励或惩罚医院的新国家政策举措 根据患者体验指标的表现，需要了解医院是否 过分关心少数群体的表现较差，以及我们如何进行干预。我们的工作将 检查患者和医院层面的因素，以更好地了解医院内部和医院之间的差异 患者的经历，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 数据库中有关患者住院护理体验的患者级数据来 检查四个目标。我们首先检查总体护理是否存在种族或民族差异。我们 然后检查经验差异在多大程度上归因于医院“内部”差异、“医院之间”差异 医院差异，或两者兼而有之。我们的第二个目标是研究解释或改变内部差异的因素 医院。第三，我们会考察一家医院的少数民族患者比例是否与医院有关 患者体验指标的表现，以及领导层是否对患者体验的承诺， 财务健康状况和护士人员配置水平解释了少数族裔比例与患者之间的关系 经验。最后，我们将确定这些因素在随着时间的推移改善患者体验中的作用。 我们的作品将描绘美国黑人、西班牙裔和白人在美国医院的经历的全国肖像 并提供及时数据，以确保改善护理的国家政策不会加剧不平等。我们将量化 差异存在的程度以及它们是否对某些亚群体的影响大于其他亚群体。例如，如果 经验差异在老年人或拥有大量患者的医院之间最为明显 少数民族患者，这些发现将为干预措施提供目标。机构调解员分析 应提供有用的指导，说明哪些干预措施将最有效地减少患者之间的差异 经验。最后，我们对少数族裔服务医院如何随着时间的推移而改进的纵向分析将提供关键 关于未来应在何处努力促进所有美国人之间公平、以患者为中心的护理的见解。