快讯重症监护室疼痛测量频率的种族偏见及其对早期再入院的影响

IF 4.8 3区 管理学 Q1 ENGINEERING, MANUFACTURING
Gaurav Jetley, He Zhang
{"title":"快讯重症监护室疼痛测量频率的种族偏见及其对早期再入院的影响","authors":"Gaurav Jetley, He Zhang","doi":"10.1177/10591478241235003","DOIUrl":null,"url":null,"abstract":"A significant portion of hospitalizations result in readmissions, many of which are preventable. Additionally, over a quarter of admissions necessitate intensive care unit (ICU) stays. These trends impose significant strain on healthcare systems, leading to penalties and reduced reimbursements for healthcare facilities. Consequently, reducing readmissions stands as a critical priority for healthcare institutions, with a specific focus on ICU processes and procedures. While some healthcare processes, such as vital sign monitoring, are consistent across patient cohorts, disparities in pain management have been well-documented. Existing research predominantly explores biases in outpatient settings, particularly in the underestimation and undertreatment of pain for Black patients. However, these biases can extend to the frequency of pain measurements in ICUs, where continuous monitoring plays a pivotal role in patient care. This study investigates disparities in pain measurement frequencies in ICUs for patients of different races and their impact on early readmission rates. Utilizing a dataset of ICU stays from a major U.S. healthcare institution, we employ mediation analysis with instrumental variables by performing a 2-step mediation analysis using IV-Probit estimator to answer these research questions. Our findings reveal that the frequency of pain measurements in ICU stays partially mediate the relationship between a patient's race and the probability of early readmission. Specifically, Black patients receive fewer pain measurements during their ICU stays compared to White patients, increasing their likelihood of 30-day readmission. This study represents the first to demonstrate that bias in pain management extends to the frequency of pain measurements in intensive care settings, shedding light on a critical aspect of healthcare disparities and their impact on readmission rates. The implications of our findings span healthcare practice, operations, and the growing body of literature on healthcare equity, offering valuable insights into addressing these disparities.","PeriodicalId":20623,"journal":{"name":"Production and Operations Management","volume":null,"pages":null},"PeriodicalIF":4.8000,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"EXPRESS: Racial Bias in Pain Measurement Frequency in ICUs and Its Impact on Early Readmission\",\"authors\":\"Gaurav Jetley, He Zhang\",\"doi\":\"10.1177/10591478241235003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"A significant portion of hospitalizations result in readmissions, many of which are preventable. Additionally, over a quarter of admissions necessitate intensive care unit (ICU) stays. These trends impose significant strain on healthcare systems, leading to penalties and reduced reimbursements for healthcare facilities. Consequently, reducing readmissions stands as a critical priority for healthcare institutions, with a specific focus on ICU processes and procedures. While some healthcare processes, such as vital sign monitoring, are consistent across patient cohorts, disparities in pain management have been well-documented. Existing research predominantly explores biases in outpatient settings, particularly in the underestimation and undertreatment of pain for Black patients. However, these biases can extend to the frequency of pain measurements in ICUs, where continuous monitoring plays a pivotal role in patient care. This study investigates disparities in pain measurement frequencies in ICUs for patients of different races and their impact on early readmission rates. Utilizing a dataset of ICU stays from a major U.S. healthcare institution, we employ mediation analysis with instrumental variables by performing a 2-step mediation analysis using IV-Probit estimator to answer these research questions. Our findings reveal that the frequency of pain measurements in ICU stays partially mediate the relationship between a patient's race and the probability of early readmission. Specifically, Black patients receive fewer pain measurements during their ICU stays compared to White patients, increasing their likelihood of 30-day readmission. This study represents the first to demonstrate that bias in pain management extends to the frequency of pain measurements in intensive care settings, shedding light on a critical aspect of healthcare disparities and their impact on readmission rates. The implications of our findings span healthcare practice, operations, and the growing body of literature on healthcare equity, offering valuable insights into addressing these disparities.\",\"PeriodicalId\":20623,\"journal\":{\"name\":\"Production and Operations Management\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.8000,\"publicationDate\":\"2024-02-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Production and Operations Management\",\"FirstCategoryId\":\"91\",\"ListUrlMain\":\"https://doi.org/10.1177/10591478241235003\",\"RegionNum\":3,\"RegionCategory\":\"管理学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ENGINEERING, MANUFACTURING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Production and Operations Management","FirstCategoryId":"91","ListUrlMain":"https://doi.org/10.1177/10591478241235003","RegionNum":3,"RegionCategory":"管理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ENGINEERING, MANUFACTURING","Score":null,"Total":0}
引用次数: 0

摘要

相当一部分住院病人会再次入院,其中许多是可以避免的。此外,超过四分之一的入院患者需要入住重症监护室 (ICU)。这些趋势给医疗系统造成了巨大压力,导致医疗机构受到处罚和报销额度减少。因此,降低再入院率成为医疗机构的当务之急,而重症监护室流程和程序则是其中的重点。虽然某些医疗流程(如生命体征监测)在不同的病人群体中是一致的,但疼痛管理方面的差异已被充分证明。现有研究主要探讨门诊环境中的偏差,尤其是低估和治疗黑人患者疼痛的偏差。然而,这些偏差可能会延伸到重症监护室的疼痛测量频率,因为在重症监护室中,持续监测在患者护理中起着至关重要的作用。本研究调查了重症监护室中不同种族患者疼痛测量频率的差异及其对早期再入院率的影响。我们利用美国一家大型医疗机构的 ICU 住院数据集,通过使用 IV-Probit 估计器进行两步中介分析,采用工具变量中介分析来回答这些研究问题。我们的研究结果表明,在重症监护室住院期间进行疼痛测量的频率在一定程度上调节了患者的种族与提前再入院概率之间的关系。具体来说,与白人患者相比,黑人患者在重症监护室住院期间接受疼痛测量的次数较少,这增加了他们 30 天内再次入院的可能性。这项研究首次证明了疼痛管理中的偏差延伸到重症监护环境中的疼痛测量频率,揭示了医疗差异的一个重要方面及其对再入院率的影响。我们的研究结果对医疗实践、运营和日益增多的医疗公平文献都有影响,为解决这些差异提供了宝贵的见解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
EXPRESS: Racial Bias in Pain Measurement Frequency in ICUs and Its Impact on Early Readmission
A significant portion of hospitalizations result in readmissions, many of which are preventable. Additionally, over a quarter of admissions necessitate intensive care unit (ICU) stays. These trends impose significant strain on healthcare systems, leading to penalties and reduced reimbursements for healthcare facilities. Consequently, reducing readmissions stands as a critical priority for healthcare institutions, with a specific focus on ICU processes and procedures. While some healthcare processes, such as vital sign monitoring, are consistent across patient cohorts, disparities in pain management have been well-documented. Existing research predominantly explores biases in outpatient settings, particularly in the underestimation and undertreatment of pain for Black patients. However, these biases can extend to the frequency of pain measurements in ICUs, where continuous monitoring plays a pivotal role in patient care. This study investigates disparities in pain measurement frequencies in ICUs for patients of different races and their impact on early readmission rates. Utilizing a dataset of ICU stays from a major U.S. healthcare institution, we employ mediation analysis with instrumental variables by performing a 2-step mediation analysis using IV-Probit estimator to answer these research questions. Our findings reveal that the frequency of pain measurements in ICU stays partially mediate the relationship between a patient's race and the probability of early readmission. Specifically, Black patients receive fewer pain measurements during their ICU stays compared to White patients, increasing their likelihood of 30-day readmission. This study represents the first to demonstrate that bias in pain management extends to the frequency of pain measurements in intensive care settings, shedding light on a critical aspect of healthcare disparities and their impact on readmission rates. The implications of our findings span healthcare practice, operations, and the growing body of literature on healthcare equity, offering valuable insights into addressing these disparities.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Production and Operations Management
Production and Operations Management 管理科学-工程:制造
CiteScore
7.50
自引率
16.00%
发文量
278
审稿时长
24 months
期刊介绍: The mission of Production and Operations Management is to serve as the flagship research journal in operations management in manufacturing and services. The journal publishes scientific research into the problems, interest, and concerns of managers who manage product and process design, operations, and supply chains. It covers all topics in product and process design, operations, and supply chain management and welcomes papers using any research paradigm.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信