Little is known about the quality of care that veterans obtain in the private sector. To explore this issue, we identified the hospital in which 4,008 veterans enrolled in the Veterans Administration (VA) obtained coronary artery bypass graft (CABG) surgery in the New York private sector between 1997 and 2000. We used published risk-adjusted mortality rates to assign New York CABG centers to performance quintiles. VA patients with the lowest incomes were 2.4 times more likely than those in the highest incomes to use the highest-mortality hospitals (95 percent CI: 2.0-3.0). Compared with white patients, black (OR 1.8; 95 percent CI: 1.2-2.8) and Hispanic VA patients (OR 1.6; 95 percent CI: 0.9-2.8) were more likely to use the highest-mortality hospitals. About one third of patients using the highest-mortality hospitals lived closer to low-mortality hospitals. Efforts to direct VA patients' care to high-performance hospitals could improve outcomes and reduce racial and ethnic disparities in care.

译文

:关于退伍军人在私营部门获得的护理质量知之甚少。为了探讨这个问题,我们确定了1997年至2000年之间,退伍军人管理局(VA)招募的4,008名退伍军人在纽约的私营部门进行了冠状动脉搭桥术(CABG)手术的医院。将纽约CABG中心分配给绩效五分位数。收入最低的VA患者使用死亡率最高的医院的可能性是收入最高的VA患者的2.4倍(95%CI:2.0-3.0)。与白人患者相比,黑人(OR 1.8; 95%CI:1.2-2.8)和西班牙裔VA患者(OR 1.6; 95%CI:0.9-2.8)更倾向于使用死亡率最高的医院。使用死亡率最高的医院的患者中,约有三分之一居住在死亡率较低的医院附近。将VA患者的护理直接转移到高性能医院的努力可以改善治疗效果,并减少种族和种族之间的护理差距。

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