Racial disparities in hospital use and quality of care for coronary heart disease

冠心病医院使用和护理质量的种族差异

基本信息

批准号：
8629501
负责人：
Ioana Popescu
金额：
$ 38.73万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-01-01 至 2016-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8629501
关键词：
Accounting Acute myocardial infarction Address Admission activity Affect American Heart Association American Hospital Association Angioplasty Area Behavior Bypass Cardiac Caring Censuses Characteristics Choice Behavior Clinical Clinical Medicine Code Communities Community Healthcare Coronary Coronary Artery Bypass Coronary heart disease Data Sources Disadvantaged Disease Outcome Event Geography Health Services Research Healthcare Heart Diseases Home environment Hospitals Institution Intervention Knowledge Life Location Marketing Measures Medicare Methods Morbidity - disease rate Neighborhoods Operative Surgical Procedures Pathway interactions Patient Care Patients Pattern Performance Physicians Play Policy Maker Population Population Study Procedures Public Health Public Policy Publishing Quality of Care Recurrence Relative (related person)Reperfusion Therapy Research Role Social Environment Surveys Symptoms Travel Trust base burden of illness demographics design health care delivery health care quality health economics improved member mortality novel strategies percutaneous coronary intervention public health relevance racial difference segregation social

项目摘要

DESCRIPTION (provided by applicant): Research suggests that racial disparities in heart disease treatment are due in part to differences in the quality of hospitals used by white and black patients. One possible explanation is that blacks live in neighborhoods with worse hospitals. However, recent studies have found that blacks are also more likely than whites to travel beyond reputable, high quality hospitals, especially for non-urgent specialized treatments, even when they live close to these facilities. Thus, factors other than location may play a role in how blacks and whites use high and low quality hospitals. We assume that, even after accounting for location, black patients are more likely to use lower quality hospital and hospitals that are located in majority black neighborhoods or have a sizable black clientele. This may be the consequence of differences in physician referrals or patient distrust of predominantly white institutions, and is likely to result in higher rates of bypass of high-quality hospitals among blacks. We further assume that the racial differences in how blacks and whites use high and low quality hospitals are more pronounced in metro areas with high residential segregation and in neighborhoods with high social disadvantage. The proposed research will focus on three cardiac conditions with various degrees of acuity - acute myocardial infarction, angioplasty, and coronary artery bypass surgery - and will use several national data sources, including Medicare files to identify patients and hospitals they use; American Hospital Association surveys for hospital characteristics; and the US Census to obtain zip code and metro area demographics and segregation measures. Analyses will employ state-of-the-art methods developed specifically for the study of hospital choice. The study will enhance our understanding of causal pathways in health care disparities by answering important questions related to factors contributing to racial differences in hospital care for the treatment of heart disease. Does geography play a role in black and white seniors' access to high quality hospitals? Is a hospital's neighborhood racial composition particularly salient to black seniors? Are these effects modified by the degree of metro area residential segregation? What is the contribution of differences in geographic access, and of differences in how black and white seniors choose hospitals, to the segregation of health care quality? The proposed study will address these and many more questions. Further, by quantifying the relative roles of geography and hospital choice behavior, the study will provide valuable information to local policy makers aiming to reduce disparities in their respective metro areas.

描述（由申请人提供）：研究表明，心脏病治疗中的种族差异部分是由于白人和黑人患者就读的医院质量不同造成的。一种可能的解释是，黑人居住的社区医院条件较差。然而，最近的研究发现，黑人也比白人更有可能前往信誉良好的高质量医院，特别是接受非紧急的专门治疗，即使他们住在这些设施附近。因此，位置以外的因素也可能发挥作用。黑人和白人如何使用高质量和低质量的医院。我们假设，即使考虑了位置，黑人患者也更有可能使用质量较低的医院位于黑人占多数的社区或拥有大量黑人顾客。这可能是由于医生转诊差异或患者对以白人为主的机构不信任造成的，并可能导致黑人绕过优质医院的比例更高。我们进一步假设，黑人和白人如何使用高质量和低质量医院的种族差异在居住隔离程度较高的都市区和社会劣势较高的社区中更为明显。拟议的研究将重点关注三种不同严重程度的心脏疾病——急性心肌梗塞、血管成形术和冠状动脉搭桥手术——并将使用多个国家数据源，包括医疗保险文件来识别患者和他们使用的医院；美国医院协会对医院特征的调查；以及美国人口普查，以获取邮政编码和都市区的人口统计数据以及隔离措施。分析将采用专门为研究医院选择而开发的最先进的方法。该研究将通过回答与导致心脏病治疗医院护理中种族差异的因素相关的重要问题，增强我们对医疗保健差异因果关系的理解。地理位置对黑人和白人老年人进入高质量医院的机会有影响吗？是一家医院的社区种族构成对黑人老年人尤其重要？这些影响是否会因都市区居住隔离的程度而改变？地域访问的差异以及黑人和白人老年人选择医院的差异对医疗保健质量的隔离有何贡献？拟议的研究将解决这些问题以及更多问题。此外，通过量化地理位置和医院选择行为的相对作用，该研究将为当地政策制定者提供有价值的信息，旨在减少各自都市区的差异。