Trends in Racial Disparities in Surgical Readmissions and Strategies to Narrow the Gap

再入院手术的种族差异趋势和缩小差距的策略

基本信息

批准号：
9572959
负责人：
ASHISH K JHA
金额：
$ 20.25万
依托单位：
HARVARD SCHOOL OF PUBLIC HEALTH
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-26 至 2020-05-31
项目状态：
已结题

项目摘要

Project Summary Disparities in surgical care, including access to and quality of care, are pervasive and long standing in our healthcare system. Black patients are much less likely to receive life-saving or life-enhancing surgical procedures, and when they do, they are more likely to experience poor clinical outcomes, including higher readmission rates and mortality, compared with white patients. We know, for instance, that there are racial disparities in surgical readmissions but we don't understand the reasons that underlie these differences. Reducing surgical readmissions has become a national priority because it likely reflects complex and critical aspects of care that requires communication and coordination between providers and patients, appropriate recovery from complications, and generally safer, better care. There have been a series of national programs, culminating in specific initiatives under the Affordable Care Act, which have focused on reducing readmissions. As these national programs have taken hold, we have little information about whether there have been reductions in surgical disparities. Just as importantly, we know little about the specific initiatives that organizations have undertaken to reduce disparities and achieve greater health equity. Therefore, we propose to use ten years of longitudinal national Medicare data to examine trends in 30-day surgical readmissions rates in black and white patients, determine whether differences have narrowed over time, identify market-level and hospital-level factors that are associated with the greatest improvement in disparities, and finally, using a national survey of hospital leaders, determine promising strategies to improve outcomes of minority populations. As the nation continues to shift towards value-based care, assessing what progress has been made in reducing disparities in surgical care, where gaps still persist, and what kinds of readmissions strategies appear most promising are all critical to informing future policy and clinical efforts to reduce gaps and ensure greater equity in surgical care.

项目概要外科护理方面的差异，包括护理的获取和质量，在各地区普遍存在且长期存在。我们的医疗保健系统。黑人患者接受挽救生命或增强生命的手术的可能性要小得多当他们这样做时，他们更有可能经历不良的临床结果，包括与白人患者相比，再入院率和死亡率更高。例如，我们知道有手术再入院方面存在种族差异，但我们不明白造成这些差异的原因差异。减少手术再入院已成为国家优先事项，因为它可能反映出护理的复杂和关键方面需要提供者之间的沟通和协调和患者，并发症的适当康复，以及通常更安全、更好的护理。曾经有过一系列国家计划，最终形成了《平价医疗法案》下的具体举措，重点是减少再入院。随着这些国家计划的实施，我们几乎没有什么有关手术差异是否减少的信息。同样重要的是，我们对各组织为减少差距而采取的具体举措知之甚少实现更大的健康公平。因此，我们建议用十年纵向的全民医保用于检查黑人和白人患者 30 天手术再入院率趋势的数据，确定差异是否随着时间的推移而缩小，确定市场层面和医院层面的因素与差异的最大改善相关，最后，使用全国医院调查领导人确定有希望的战略，以改善少数民族人口的成果。作为国家继续转向基于价值的护理，评估在减少手术治疗方面的差异，差距仍然存在，以及出现什么样的再入院策略最有希望的都对于为未来的政策和临床工作提供信息至关重要，以缩小差距并确保手术护理更加公平。