Multilevel Examination of Hospital Participation in the Healthcare Equality Index (HEI): The Role of Geographic Location and State Health Care Policies.

IF 3.6 1区医学 Q1 PSYCHOLOGY, SOCIAL

Journal of Health and Social Behavior Pub Date : 2025-08-03 DOI:10.1177/00221465251355487

Hyunmin Yu,Matthew D McHugh,Stephen Bonett,Daniela Golinelli,Tari Hanneman,José A Bauermeister

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Abstract

The Healthcare Equality Index (HEI) evaluates compliance with LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender diverse individuals) inclusion in U.S. health care facilities and is associated with greater patient satisfaction. We examined how hospitals' metropolitan location and state-level LGBTQ+ health care policies are associated with voluntary HEI participation and performance. This cross-sectional study analyzed 6,120 U.S. hospitals from the 2022 American Hospital Association Annual Survey. Multilevel logistic regression assessed the relationship and varying impact of metropolitan status and state policies on HEI participation and HEI Leader status (highest performance). State policies had a stronger positive association with nonmetropolitan hospitals. Each additional policy increased HEI participation odds by 58% for nonmetropolitan hospitals (adjusted odds ratio [aOR] = 1.58; 95% confidence interval [CI] = 1.19, 2.10) and 21% for metropolitan hospitals (aOR = 1.21; 95% CI = 1.02, 1.43). No significant associations with HEI Leader status were observed. Strengthening LGBTQ+ inclusive state policies may encourage hospitals, particularly in nonmetropolitan areas, to adopt LGBTQ+ inclusion initiatives.

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医院参与医疗保健平等指数（HEI）的多层次检验：地理位置和国家医疗保健政策的作用。

医疗保健平等指数（HEI）评估美国医疗保健机构对LGBTQ+（女同性恋、男同性恋、双性恋、变性人、酷儿或质疑者，以及其他性和性别多样化的个体）纳入的依从性，并与更高的患者满意度相关。我们研究了医院的大都市位置和国家级LGBTQ+医疗保健政策与自愿参与HEI和绩效之间的关系。这项横断面研究分析了2022年美国医院协会年度调查中的6120家美国医院。多层次逻辑回归评估了大都市地位和国家政策对高等教育参与和高等教育领导者地位（最高绩效）的关系和不同影响。国家政策与非大都市医院有更强的正相关关系。每增加一份保单，非大都市医院参与HEI的几率增加58%(调整后的优势比[aOR] = 1.58；95%置信区间[CI] = 1.19, 2.10)和21% (aOR = 1.21；95% ci = 1.02, 1.43)。未观察到与HEI Leader状态有显著关联。加强对LGBTQ+包容的州政策可能会鼓励医院，特别是非大都市地区的医院，采取包容LGBTQ+的举措。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Health and Social Behavior Multiple-

CiteScore

6.50

自引率

4.00%

发文量

期刊介绍： Journal of Health and Social Behavior is a medical sociology journal that publishes empirical and theoretical articles that apply sociological concepts and methods to the understanding of health and illness and the organization of medicine and health care. Its editorial policy favors manuscripts that are grounded in important theoretical issues in medical sociology or the sociology of mental health and that advance theoretical understanding of the processes by which social factors and human health are inter-related.