Disparities in Health Care Are Driven by Where Minority Patients Seek Care

Abstract

Background: Racial/ethnic disparities in health care are well documented, but less is known about whether disparities occur within or between hospitals for specific inpatient processes of care. We assessed racial/ethnic disparities using the Hospital Quality Alliance Inpatient Quality of Care Indicators. Methods: We performed an observational study using patient-level data for acute myocardial infarction (5 care measures), congestive heart failure (2 measures), community-acquired pneumonia (2 measures), and patient counseling (4 measures). Data were obtained from 123 hospitals reporting to the University HealthSystem Consortium from the third quarter of 2002 to the first quarter of 2005. A total of 320 970 patients 18 years or older were eligible for at least 1 of the 13 measures. Results: There were consistent unadjusted differences between minority and nonminority patients in the quality of care across 8 of 13 quality measures (from 4.63 and 4.55 percentage points for angiotensin-converting enzyme inhibitors for acute myocardial infarction and con-gestive heart failure [PϽ.01] to 14.58 percentage points for smoking cessation counseling for pneumonia [P=.02]). Disparities were most pronounced for counseling measures. In multivariate models adjusted for individual patient characteristics and hospital effect, the magnitude of the disparities decreased substantially, yet remained significant for 3 of the 4 counseling measures; acute myocardial infarction (unadjusted, 9.00 [PϽ.001]; adjusted, 3.82 [PϽ.01]), congestive heart failure (unadjusted, 8.45 [P = .02]; adjusted, 3.54 [P = .02]), and community-acquired pneumonia (unadjusted, 14.58 [P =.02]; adjusted, 4.96 [P =.01]). Conclusions: Disparities in clinical process of care measures are largely the result of differences in where minority and nonminority patients seek care. However, disparities in services requiring counseling exist within hospitals after controlling for site of care. Policies to reduce disparities should consider the underlying reasons for the disparities.

Residential Racial Composition, Spatial Access to Care, and Breast Cancer Mortality among Women in Georgia

“…While our findings are consistent with a large body of literature documenting the association of poorer health outcomes with increasing percent of local residents who are Black, and with racial segregation, [47][48][49][50][51][52][53][54][55][56] they run counter to findings from the emerging literature that focuses exclusively on these exposures' relationship to breast cancer mortality. Haas et al 15 found no relationship between racial segregation (operationalized as isolation) and breast cancer mortality, and Warner and Gomez 16 found an inverse relationship between Black neighborhood racial composition and breast cancer mortality among Black women and a positive relationship for White women, controlling for metropolitan segregation.…”

“…Several studies found evidence that racial minorities are more likely to receive care from lower quality facilities than their White counterparts. [52][53][54]62 For example, hospital and physician "volume" is thought to be connected to quality of care. 55 In a recent study where there was an established association between volume and mortality, Black patients in New York City were at a double disadvantage because they were less likely than their White counterparts to use high-volume hospitals and surgeons for breast cancer surgery.…”

Ethnicity and management of colon cancer in New Zealand

“…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).…”

Understanding Stress Among Adults Diagnosed with Type 2 Diabetes at a Younger Age

“…Researchers should consider recruiting participants from settings such as county health departments and hospital emergency rooms [23]. Future studies should also examine how diabetes-related distress, self-efficacy, and coping methods may vary depending on life-stage (e.g.…”