本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2023.24874

摘要内容如下：

重要性

公平是卫生保健质量的一个重要领域。医疗保险和医疗补助服务中心（CMS）开发了两种差异方法，共同评估临床结果的公平性。

目标

确定公平重新接纳的措施；根据保险（双重资格与非双重资格）或患者种族（黑人与白人）确定具有公平再入院率的医院；并通过医院特征和责任措施（质量、成本和价值）的绩效来比较有和没有公平再入院的医院。

设计、设置和参与者

使用2018年7月至2019年6月的医疗保险数据，对符合CMS全院再入院标准的美国医院进行横断面研究。

主要成果和措施

我们使用CMS差异方法创建了公平再入院的定义，该方法根据两种方法评估医院：差异风险人群的结果（跨医院方法）；以及医院患者群体内的护理差异（单一医院内方法）。

曝光

医院患者人口统计学；医院特色；以及医院绩效-质量、成本和价值（相对于成本的质量）的3个指标。

结果

在4638家医院中，74%的医院为足够数量的双重资格患者提供服务，42%的医院为足够数量的黑人患者提供服务，以根据保险和种族应用CMS差异方法。在符合条件的医院中，17%的医院因保险而有公平的再入院率，30%的医院因种族而有公平的再入院率。按保险或种族公平再入院的医院照顾黑人患者的比例较低（保险，1.9%[IQR，0.2%-8.8%]vs 3.3%[IQR，0.7%-10.8%]，P<.01；种族，7.6%[IQR，3.2%-16.6%]vs 9.3%[IQR，4.0%-19.0%]，P=.01），并且在多个领域（教学状况、地理、规模；P<.01）。在通过保险检查公平性时，费用低的医院更可能有公平的再入院率（优势比，1.57[95%CI，1.38-1.77]），并且质量和价值与公平性之间没有关系。在按种族检查公平性时，整体质量高的医院更可能有公平的再入院率（优势比，1.14[95%CI，1.03-1.26]），并且成本和价值与公平性之间没有关系。

结论和相关性

少数医院实现了公平再入院。值得注意的是，有公平再入院率的医院与没有公平再入院率的医院在特征上是不同的。例如，公平再入院的医院为黑人患者提供的服务较少，这强化了结构性种族主义在医院层面不平等中的作用。公平再入院措施的实施必须考虑到高危患者在医院中的不平等分布。

英文原文如下：

Abstracts

Importance  Equity is an essential domain of health care quality. The Centers for Medicare & Medicaid Services (CMS) developed 2 Disparity Methods that together assess equity in clinical outcomes.

Objectives  To define a measure of equitable readmissions; identify hospitals with equitable readmissions by insurance (dual eligible vs non-dual eligible) or patient race (Black vs White); and compare hospitals with and without equitable readmissions by hospital characteristics and performance on accountability measures (quality, cost, and value).

Design, Setting, and Participants  Cross-sectional study of US hospitals eligible for the CMS Hospital-Wide Readmission measure using Medicare data from July 2018 through June 2019.

Main Outcomes and Measures  We created a definition of equitable readmissions using CMS Disparity Methods, which evaluate hospitals on 2 methods: outcomes for populations at risk for disparities (across-hospital method); and disparities in care within hospitals' patient populations (within-a-single-hospital method).

Exposures  Hospital patient demographics; hospital characteristics; and 3 measures of hospital performance-quality, cost, and value (quality relative to cost).

Results  Of 4638 hospitals, 74% served a sufficient number of dual-eligible patients, and 42% served a sufficient number of Black patients to apply CMS Disparity Methods by insurance and race. Of eligible hospitals, 17% had equitable readmission rates by insurance and 30% by race. Hospitals with equitable readmissions by insurance or race cared for a lower percentage of Black patients (insurance, 1.9% [IQR, 0.2%-8.8%] vs 3.3% [IQR, 0.7%-10.8%], P < .01; race, 7.6% [IQR, 3.2%-16.6%] vs 9.3% [IQR, 4.0%-19.0%], P = .01), and differed from nonequitable hospitals in multiple domains (teaching status, geography, size; P < .01). In examining equity by insurance, hospitals with low costs were more likely to have equitable readmissions (odds ratio, 1.57 [95% CI, 1.38-1.77), and there was no relationship between quality and value, and equity. In examining equity by race, hospitals with high overall quality were more likely to have equitable readmissions (odds ratio, 1.14 [95% CI, 1.03-1.26]), and there was no relationship between cost and value, and equity.

Conclusion and Relevance  A minority of hospitals achieved equitable readmissions. Notably, hospitals with equitable readmissions were characteristically different from those without. For example, hospitals with equitable readmissions served fewer Black patients, reinforcing the role of structural racism in hospital-level inequities. Implementation of an equitable readmission measure must consider unequal distribution of at-risk patients among hospitals.

-----------分割线---------

点击链接：https://www.mediecogroup.com/community/user/vip/categories/ ，成为医咖会员，获取12项专属权益。

现在购买可享受最大优惠（买一年送三个月，买两年送一年），2024年2月10日起将不再享有该优惠。