背景:放置外周静脉导管(PIVC)是医院环境中的常规程序。主要目标是探索医疗保健不平等与PIVC结果之间的关系。
方法:这项研究是一个多中心,1月1日之间需要住院的急诊科建立的成人PIVC访问的观察分析,2021年1月31日,2023年,在底特律地铁,密歇根州,美国。流行病学,人口统计学,治疗性的,临床,并收集结果数据。国家少数民族健康和健康差异研究所定义了健康差异。主要结果是PIVC停留时间与住院时间的比例,表示为停留时间(小时)与住院时间(小时)的比例×100%。多变量线性回归和机器学习模型用于变量选择。随后,采用多元线性回归分析对混杂因素进行校正,并对每个变量的真实效应进行最佳估计.
结果:1月1日之间,2021年1月31日,2023年,我们的研究分析了144,524次ED遭遇,患者平均年龄为65.7岁,53.4%为女性。种族人口统计数据显示67.2%的白人,和27.0%的黑人,剩下的是亚洲人,美洲印第安人阿拉斯加原住民,或其他种族。PIVC停留时间与住院时间的中位数比例为0.88,其中亚洲人的比例最高(0.94),黑人最低(0.82)。黑人女性的中位停留时间为0.76,明显低于白人男性的0.93(p<0.001)。在控制了混杂变量之后,多元线性回归表明,黑人男性和白人男性的居住比例分别为10.0%和19.6%,分别,与黑人女性相比(p<0.001)。
结论:黑人女性面临的PIVC功能受损的风险最高,导致大约整整一天的PIVC访问比白人男性更不可靠。全面解决和纠正这些差距,进一步的研究对于提高对医疗保健不平等对PIVC获取的临床影响的理解至关重要.此外,必须制定有效的策略来减轻这些差异,并确保所有个人的公平医疗结果。
BACKGROUND: Placement of peripheral intravenous catheters (PIVC) is a routine procedure in hospital settings. The primary objective is to explore the relationship between healthcare inequities and PIVC outcomes.
METHODS: This
study was a multicenter, observational analysis of adults with PIVC access established in the emergency department requiring inpatient admission between January 1st, 2021, and January 31st, 2023, in metro Detroit, Michigan, United States. Epidemiological, demographic, therapeutic, clinical, and outcomes data were collected. Health disparities were defined by the National Institute on Minority Health and Health Disparities. The primary outcome was the proportion of PIVC dwell time to hospitalization length of stay, expressed as the proportion of dwell time (hours) to hospital stay (hours) x 100%. Multivariable linear regression and a machine learning model were used for variable selection. Subsequently, a multivariate linear regression analysis was utilized to adjust for confounders and best estimate the true effect of each variable.
RESULTS: Between January 1st, 2021, and January 31st, 2023, our
study analyzed 144,524 ED encounters, with an average patient age of 65.7 years and 53.4% female. Racial demographics showed 67.2% White, and 27.0% Black, with the remaining identifying as Asian, American Indian Alaska Native, or other races. The median proportion of PIVC dwell time to hospital length of stay was 0.88, with individuals identifying as Asian having the highest ratio (0.94) and Black individuals the lowest (0.82). Black females had a median dwell time to stay ratio of 0.76, significantly lower than White males at 0.93 (p < 0.001). After controlling for confounder variables, a multivariable linear regression demonstrated that Black males and White males had a 10.0% and 19.6% greater proportion of dwell to stay, respectively, compared to Black females (p < 0.001).
CONCLUSIONS: Black females face the highest risk of compromised PIVC functionality, resulting in approximately one full day of less reliable PIVC access than White males. To comprehensively address and rectify these disparities, further research is imperative to improve understanding of the clinical impact of healthcare inequities on PIVC access. Moreover, it is essential to formulate effective strategies to mitigate these disparities and ensure equitable healthcare outcomes for all individuals.