By Christopher Cheney
Differences in the quality of hospitals that Black and White patients access are a driver of patient safety disparities between Black and White patients, a new report says.
Racial care disparities have been a concern in U.S. healthcare for decades. These disparities have drawn heightened attention during the coronavirus pandemic because Black, Hispanic, American Indian, and Alaska Native COVID-19 patients have experienced disproportionately high rates of negative outcomes including mortality.
The new report, which was conducted by researchers at the Urban Institute with funding from the Robert Wood Johnson Foundation, examines 2017 hospital discharge data from the Agency for Healthcare Research and Quality’s Cost and Utilization Project. The researchers also used AHRQ software to focus on 11 patient safety indicators.
Four of the patient safety indicators were categorized as “general,” including pressure ulcer rate and central venous catheter-related blood stream infection rate. The other seven patient safety indicators were categorized as “surgery-related,” including perioperative hemorrhage or hematoma rate and postoperative sepsis rate.
The researchers also categorized hospitals as “high quality” or “low quality” based on whether a hospital was above or below the median value of each patient safety indicator.
The new report features four primary findings:
- Compared to White patients, Black patients experienced worse care quality for six of the 11 patient safety indicators. The care disparity was particularly notable for surgery-related patient safety indicators, with Black patients experiencing worse care quality compared to White patients for five of the seven measures.
- When the researchers focused on Medicare beneficiaries, there were similar Black-White disparities in patient safety indicators.
- Black patients were less likely to be admitted to high quality hospitals for nine of the eleven patient safety indicators. The care disparity was particularly notable for surgery-related patient safety indicators, with Black patients less likely to be admitted to high quality hospitals for six of the seven patient safety indicators. White patients were nine percentage points more likely to be admitted to high quality hospitals on four patient safety indicators and more than seven percentage points more likely to be admitted to high quality hospitals on six indicators.
- Compared to White patients, Black patients were less likely to be admitted to high quality hospitals for two or more of the four general patient safety indicators. Compared to White patients, Black patients were 7.9 percentage points more likely to be admitted to low quality hospitals for all seven of the surgery-related patient safety indicators. Compared to White patients, Black patients were 4.9 percentage points less likely to be admitted to high quality hospitals for all of the surgery-related patient safety indicators.
“This study finds that Black and White patients face different standards of patient safety and that some of this disparity can be attributed to differences in the quality of hospitals patients access. Black-White disparities in patient safety are larger for quality measures surrounding surgical procedures, and Black patients are significantly less likely than white patients to access the hospitals best able to minimize these adverse surgery-related patient safety risks,” the report says.
Interpreting the data
The propensity of Black patients to access low quality hospitals more often than White patients is a driver of quality disparities in hospital care, the lead author of the new report told HealthLeaders.
“We have known that Black and White patients experience different quality of hospital care for decades. The focus of this study was to ask whether these differences are, in part, driven by differences in the overall quality of hospitals that Black and White patients can access. The answer is, ‘yes.’ We find that White patients access high quality hospitals that are best able to minimize adverse safety events such as hospital-acquired illnesses or injuries,” said Anuj Gangopadhyaya, PhD, a senior research associate at Urban Institute.
There have been several policies implemented in the past several decades that might have been expected to narrow differences in the quality of care, he said. “Those policies include Medicare discontinuing reimbursing hospitals for services treating specific hospital-acquired conditions as well as penalties enforced under the Affordable Care Act. Nonetheless, we continue to see persistent differences in patient safety across hospitals.”
New policies are needed to close the Black-White patient safety gap, Gangopadhyaya said. “Black patients are consistently more likely to be admitted to hospitals that are on the worst end of patient safety measures. This is evidence that the current policies that are attempting to improve patient safety and narrow patient safety gaps are either sluggish or ineffective.”
Disparities in surgery-related patient safety measures are “concerning to say the least,” he said.
“The biggest disparities and patient safety gaps between Black and White patients are for surgery-related patient safety measures. At the population level, Black patients are far more likely than White patients to suffer from sepsis infections, pulmonary embolism, respiratory failure, and other horrible conditions that occur during or after a surgical procedure,” Gangopadhyaya said.
The Affordable Care Act has not been effective in addressing this disparity, he said.
“It was well established before the Affordable Care Act that Black patients were consistently more likely to receive treatment at hospitals that were considered low quality with regard to surgery performance. In our research, we were interested in whether that story had changed at all in the post-Affordable Care Act world. The ACA was intended to improve healthcare access and affordability for vulnerable populations. Our results suggest there has been little change on this front. We continue to see patient safety gaps and differences in the quality of hospitals used by patients, particularly for surgical procedures.”
Christopher Cheney is the senior clinical care editor at HealthLeaders.