Use of hospitals in the New York City Metropolitan Region, by race: how separate? How equal in resources and quality?

Liu, Bian; Ornstein, Katherine; Frydman, Julia L.; Kelley, Amy S.; Benn, Emma K. T.; Siu, Albert L.

doi:10.1186/s12913-022-08414-3

Cited by 3 publications

(2 citation statements)

References 46 publications

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“…However, a hospital's payor and racial mix may also represent systematic exclusion of dual-eligible and Black patients. [60][61][62] CMS proposed health equity adjustment, which incorporates care for a high proportion of underserved and/or dual-eligible beneficiaries into criteria for payment programs, is a potential policy solution to address these challenges. 63,64 Measuring equity in outcomes is a relatively new concept in quality measurement.…”

Section: Discussionmentioning

confidence: 99%

“…Differences in patient population may reflect differences in catchment area demographics, secondary to longstanding income and racial segregation. However, a hospital’s payor and racial mix may also represent systematic exclusion of dual-eligible and Black patients . CMS proposed health equity adjustment, which incorporates care for a high proportion of underserved and/or dual-eligible beneficiaries into criteria for payment programs, is a potential policy solution to address these challenges …”

Section: Discussionmentioning

confidence: 99%

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Measuring Equity in Readmission as a Distinct Assessment of Hospital Performance

Nash,

Weerahandi,

et al. 2024

JAMA

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ImportanceEquity is an essential domain of health care quality. The Centers for Medicare &amp; Medicaid Services (CMS) developed 2 Disparity Methods that together assess equity in clinical outcomes.ObjectivesTo define a measure of equitable readmissions; identify hospitals with equitable readmissions by insurance (dual eligible vs non–dual eligible) or patient race (Black vs White); and compare hospitals with and without equitable readmissions by hospital characteristics and performance on accountability measures (quality, cost, and value).Design, Setting, and ParticipantsCross-sectional study of US hospitals eligible for the CMS Hospital-Wide Readmission measure using Medicare data from July 2018 through June 2019.Main Outcomes and MeasuresWe created a definition of equitable readmissions using CMS Disparity Methods, which evaluate hospitals on 2 methods: outcomes for populations at risk for disparities (across-hospital method); and disparities in care within hospitals’ patient populations (within-a-single-hospital method).ExposuresHospital patient demographics; hospital characteristics; and 3 measures of hospital performance—quality, cost, and value (quality relative to cost).ResultsOf 4638 hospitals, 74% served a sufficient number of dual-eligible patients, and 42% served a sufficient number of Black patients to apply CMS Disparity Methods by insurance and race. Of eligible hospitals, 17% had equitable readmission rates by insurance and 30% by race. Hospitals with equitable readmissions by insurance or race cared for a lower percentage of Black patients (insurance, 1.9% [IQR, 0.2%-8.8%] vs 3.3% [IQR, 0.7%-10.8%], P &lt; .01; race, 7.6% [IQR, 3.2%-16.6%] vs 9.3% [IQR, 4.0%-19.0%], P = .01), and differed from nonequitable hospitals in multiple domains (teaching status, geography, size; P &lt; .01). In examining equity by insurance, hospitals with low costs were more likely to have equitable readmissions (odds ratio, 1.57 [95% CI, 1.38-1.77), and there was no relationship between quality and value, and equity. In examining equity by race, hospitals with high overall quality were more likely to have equitable readmissions (odds ratio, 1.14 [95% CI, 1.03-1.26]), and there was no relationship between cost and value, and equity.Conclusion and RelevanceA minority of hospitals achieved equitable readmissions. Notably, hospitals with equitable readmissions were characteristically different from those without. For example, hospitals with equitable readmissions served fewer Black patients, reinforcing the role of structural racism in hospital-level inequities. Implementation of an equitable readmission measure must consider unequal distribution of at-risk patients among hospitals.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Measuring Equity in Readmission as a Distinct Assessment of Hospital Performance

Nash,

Weerahandi,

et al. 2024

JAMA

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Annual income, age, marital status, and smoking influence healthcare access among American minorities and Caucasians with knee osteoarthritis

Vennu

Abdulrahman

Alenazi

et al. 2023

International Journal of Healthcare Management

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Treatment patterns and outcomes of Medicare enrolees who developed venous leg ulcers

Tettelbach,

Driver,

Oropallo

et al. 2023

J Wound Care

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Objective: To retrospectively evaluate the comorbidities, treatment patterns and outcomes of Medicare enrolees who developed venous leg ulcers (VLUs). Method: Medicare Limited Data Standard Analytic Hospital Inpatient and Outpatient Department Files were used to follow patients who received medical care for a VLU between 1 October 2015 and 2 October 2019. Patients diagnosed with chronic venous insufficiency (CVI) and a VLU were propensity matched into four groups based on their treatment regimen. Episode claims were used to document demographics, comorbidities and treatments of Medicare enrolees who developed VLUs, as well as important outcomes, such as time to ulcer closure, rates of complications and hospital utilisation rates. Outcomes were compared across key propensity-matched groups. Results: In total, 42% of Medicare enrolees with CVI (n=1,225,278), developed at least one VLU during the study, and 79% had their episode claim completed within one year. However, 59% of patients developed another VLU during the study period. This analysis shows that only 38.4% of VLU episodes received documented VLU conservative care treatment. Propensity-matched episodes that received an advanced treatment or high-cost skin substitutes for a wound which had not progressed by 30 days demonstrated the best outcomes when their cellular, acellular, matrix-like product (CAMP) treatment was applied weekly or biweekly (following parameters for use). Complications such as rates of infection (33%) and emergency department visits (>50%) decreased among patients who received an advanced treatment (following parameters for use). Conclusion: Medicare enrolees with CVI have diverse comorbidities and many do not receive sufficient management, which contributes to high rates of VLUs and subsequent complications. Medicare patients at risk of a VLU who receive early identification and advanced CAMP treatment demonstrated improved quality of life and significantly reduced healthcare resource utilisation.

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Use of hospitals in the New York City Metropolitan Region, by race: how separate? How equal in resources and quality?

Cited by 3 publications

References 46 publications

Measuring Equity in Readmission as a Distinct Assessment of Hospital Performance

Measuring Equity in Readmission as a Distinct Assessment of Hospital Performance

Annual income, age, marital status, and smoking influence healthcare access among American minorities and Caucasians with knee osteoarthritis

Treatment patterns and outcomes of Medicare enrolees who developed venous leg ulcers

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