Handoffs and Equity: Impact of a Patient Distribution Model on Handoffs for Black Patients.

IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Ethan Molitch-Hou, Thomas J Best, Ellis Green, Khanh T Nguyen, Grace LaShore, Matthew T Cerasale
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引用次数: 0

Abstract

Background: Hospital medicine patient distribution models (PDM) assign patients to inpatient services on hospital admission. Models balance tradeoffs including patient handoffs, physician wellness, subspecialty care, and other factors to ensure optimal outcomes; however, equity is rarely considered. Handoffs during inpatient care can result in medical error and worse patient outcomes. This study evaluates the impact of a PDM that prioritizes use of specialty care services and an overflow service (OS) during high census on racial inequities in handoff frequency.

Methods: A single-center retrospective cohort study of inpatient encounters on hospital medicine services from July 2017 to December 2019 was conducted. The primary exposures included being discharged by a general medicine service (GMS) or cared for by an OS. The primary outcome was handoffs per day of stay, analyzed by multivariable regression adjusted for age, gender, race, ethnicity, insurance, discharge from GMS, and care from OS.

Results: A total of 4165 inpatient hospitalizations with the majority of their stay on a hospital medicine service were reviewed. Patients discharged by GMS (78.2% vs. 58.1%, p < .001) and cared for by OS (78.7% vs. 67.0%, p < .001) were more likely to identify as Black. Multivariable analysis showed a handoff risk ratio of 1.53 (p < .001) for OS patients and 1.06 (p = .01) if discharged from GMS, but race alone did not significantly affect risk of handoffs.

Conclusion: The PDM prioritization drove increased handoffs disproportionately for Black patients. Multivariable analysis showed that race alone did not contribute to increased handoffs suggesting the creation of a systemic bias in patient care.

交接与公平:病人分配模式对黑人病人交接的影响。
背景:医院医学病人分配模式(PDM)在病人入院时为其分配住院服务。该模型平衡了各种权衡因素,其中包括病人交接、医生健康、亚专科护理和其他因素,以确保最佳治疗效果;但很少考虑公平性。住院治疗期间的交接班可能会导致医疗失误和更糟糕的患者预后。本研究评估了优先使用专科护理服务的 PDM 和高人口密度时的分流服务(OS)对移交频率种族不平等的影响:对 2017 年 7 月至 2019 年 12 月期间医院医疗服务的住院病人就诊情况进行了单中心回顾性队列研究。主要暴露包括由普通内科服务(GMS)出院或由操作系统护理。主要结果是住院期间每天的交接,通过多变量回归进行分析,并对年龄、性别、种族、民族、保险、GMS出院和OS护理进行调整:共审查了 4165 名住院病人,其中大部分住院时间是在医院医疗服务部门度过的。由 GMS 出院的患者占 78.2%,由 OS 出院的患者占 58.1%:PDM 优先排序导致黑人患者的出院率不成比例地上升。多变量分析表明,种族本身并不会导致交接率增加,这表明在患者护理中存在系统性偏差。
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来源期刊
Journal of Racial and Ethnic Health Disparities
Journal of Racial and Ethnic Health Disparities PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
7.30
自引率
5.10%
发文量
263
期刊介绍: Journal of Racial and Ethnic Health Disparities reports on the scholarly progress of work to understand, address, and ultimately eliminate health disparities based on race and ethnicity. Efforts to explore underlying causes of health disparities and to describe interventions that have been undertaken to address racial and ethnic health disparities are featured. Promising studies that are ongoing or studies that have longer term data are welcome, as are studies that serve as lessons for best practices in eliminating health disparities. Original research, systematic reviews, and commentaries presenting the state-of-the-art thinking on problems centered on health disparities will be considered for publication. We particularly encourage review articles that generate innovative and testable ideas, and constructive discussions and/or critiques of health disparities.Because the Journal of Racial and Ethnic Health Disparities receives a large number of submissions, about 30% of submissions to the Journal are sent out for full peer review.
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