Hospital-Level Racial Disparities in Acute Myocardial Infarction Treatment and Outcomes

Barnato, Amber E.; Lucas, F. Lee; Staiger, Douglas O.; Wennberg, David E.; Chandra, Amitabh

doi:10.1097/01.mlr.0000156848.62086.06

Cited by 264 publications

(221 citation statements)

References 41 publications

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“…[31][32][33] These results have important implications for the VA. They support the proposition that most VA medical centers will need to measure and address racial gaps in care for their patient populations.…”

Section: Discussionmentioning

confidence: 97%

Despite Improved Quality Of Care In The Veterans Affairs Health System, Racial Disparity Persists For Important Clinical Outcomes

et al. 2011

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Both government and private health care systems have engaged in efforts to improve quality, but the effect of these initiatives on racial and ethnic disparities has not been well studied. In the decade following an organizational transformation, the Veterans Affairs (VA) health care system achieved substantial improvements in quality of care with minimal racial disparities for most process-of-care measures, such as rates of cholesterol screenings. However, in our study we observed a striking disconnect between high levels of performance on widely used process measures and modest levels of improvement in clinical outcomes, such as control of blood pressure, blood glucose, and cholesterol levels. We also observed a gap in clinical outcomes of as much as nine percentage points between African American veterans and white veterans. Almost all of the disparity in outcomes in the VA was explained by within-facility disparity, which suggests that VA medical centers need to measure and address racial gaps in care for their patient populations. Moreover, because cardiovascular disease and diabetes are major contributors to racial disparities in life expectancy, the findings of this study and others underscore the urgency of focused efforts to improve intermediate outcomes among African Americans in the VA and other settings.

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Section: Discussionmentioning

confidence: 97%

Despite Improved Quality Of Care In The Veterans Affairs Health System, Racial Disparity Persists For Important Clinical Outcomes

et al. 2011

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“…It is known that variations between health facilities contribute to treatment disparities in other countries, 18,[34][35][36][37][38][39] particularly the United States, where ethnic segregation of healthcare is marked 36,40 and is likely to be a major cause of treatment differences between black and white patients. 35,37,41,42 We made some attempt to assess the influence of facility differences on Maori/non-Maori treatment disparities by adjusting for the type of hospital where patients underwent surgery (treating this as the patient's primary treatment facility).…”

Section: Discussionmentioning

confidence: 99%

Ethnicity and management of colon cancer in New Zealand

Hill

Sarfati

Blakely

et al. 2010

Cancer

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BACKGROUND: Racial and ethnic inequalities in colon cancer treatment have been reported in the United States but not elsewhere. The authors of this report compared cancer treatment in a nationally representative cohort of Maori (indigenous) and non-Maori New Zealanders with colon cancer. METHODS: On the basis of cancer registry data, 301 Maori patients and 329 randomly selected non-Maori patients were identified who were diagnosed with colon cancer between 1996 and 2003. Medical notes were reviewed, and surgical and oncology treatments were compared by indigenous status. RESULTS: Maori and non-Maori patients had similar rates of surgical resection, although Maori patients were less likely to undergo extensive lymph node clearance and were more likely to die during the postoperative period. Maori patients were significantly less likely to receive chemotherapy for stage III disease (relative risk [RR], 0.69; 95% confidence interval [CI], 0.53-0.91) and were more likely to experience a delay of at least 8 weeks before starting chemotherapy (RR, 1.98; 95%CI, 1.23-3.16). Treatment disparities were not explained by differences in tumor characteristics or patient comorbidity. CONCLUSIONS: Maori New Zealanders with colon cancer were less likely to receive adjuvant chemotherapy and experienced a lower quality of care compared with non-Maori patients. The authors concluded that attention to health system factors is needed to ensure equal access and quality of cancer treatment for indigenous and ethnic minority populations.

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“…Based on five of the PSI quality measures (i.e., complications of anesthesia, postoperative hemorrhage or hematoma, accidental puncture or laceration, and OB trauma), one could conclude that blacks and Hispanics used higher quality hospitals. Prior studies have focused on AMI and cardiac procedures and found that blacks and Hispanics used lower quality hospitals (Bradley et al 2004;Barnato et al 2005;Hasnain-Wynia et al 2007;Skinner et al 2005). The choice of the quality indicator can influence the conclusion.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have presented evidence suggesting that race disparities in the quality of hospital care are due more to variation in quality of care across hospitals than variation in the quality of care within hospitals (Barnato et al 2005;Blustein and Weitzman 1995;Bradley et al 2004;Hasnain-Wynia et al 2007;Jha et al 2007;Skinner et al 2005). Stated simply, minority patients receive lower quality care because they are more likely to be treated in lower quality hospitals.…”

Section: Do Minority Patients Use Lower Quality Hospitals?mentioning

confidence: 99%

Do Minority Patients Use Lower Quality Hospitals?

Gaskin

Spencer

Richard

et al. 2011

INQUIRY

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Employing three years of inpatient discharge data from 11 states and inpatient and patient safety quality indicators from the Agency for Healthcare Research and Quality (AHRQ), this paper explored whether minority (black, Hispanic, and Asian) patients used lower quality hospitals. We found that the association between the share of minority patients and hospital quality depended on how quality was measured and varied by race and ethnicity. Hospitals serving Hispanics performed well on most patient safety measures. Higher percentages of all three minority patient groups corresponded to lower quality for only one measure, postoperative sepsis. Our analysis indicates that it is incorrect to generalize that minorities use lower quality hospitals. Analysts and policymakers should be cautious when making generalizations about the overall service quality of hospitals that treat minority patients.

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Hospital-Level Racial Disparities in Acute Myocardial Infarction Treatment and Outcomes

Abstract: Background-Previous studies have documented racial disparities in treatment for acute myocardial infarction (AMI) among Medicare beneficiaries. However, the extent to which unobserved differences between hospitals explain some of these differences is unknown.

Cited by 264 publications

References 41 publications

Despite Improved Quality Of Care In The Veterans Affairs Health System, Racial Disparity Persists For Important Clinical Outcomes

Despite Improved Quality Of Care In The Veterans Affairs Health System, Racial Disparity Persists For Important Clinical Outcomes

Ethnicity and management of colon cancer in New Zealand

Do Minority Patients Use Lower Quality Hospitals?

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