Racial and ethnic disparities in the quality of U.S. hospital care for patients with heart attack, heart failure and pneumonia shrank considerably between 2005 and 2010, as more patients of all races received recommended treatments, according to a national analysis by several institutions, including the University of Pittsburgh School of Medicine.
The study, published in the New England Journal of Medicine, found that care for blacks and Hispanics became better and more equitable when comparing hospitals principally serving whites to hospitals principally serving minorities and when comparing changes in care over time within the same hospitals. The work was supported by the Centers for Medicare & Medicaid Services (CMS).
“It is heartening that we found higher quality of care overall and large reductions in racial and ethnic disparities in health care for patients with these common conditions,” said senior author Michael Fine, M.D., M.Sc., professor of medicine at the University of Pittsburgh School of Medicine and staff physician at the Veterans Affairs Pittsburgh Healthcare System. “However, it is critically important to demonstrate that these improvements in care are accompanied by better patient outcomes. Further studies are needed to investigate if racial and ethnic disparities in mortality have also decreased over time.”
Dr. Fine also directs the Center for Health Equity Research and Promotion (CHERP) at the VA Pittsburgh Healthcare System, which is focused on detecting, understanding and reducing disparities in health and health care in vulnerable populations.
Dr. Fine and his co-investigators looked at more than 12 million acute care hospitalizations over the five-year span and found that, as quality of care improved and hospitals did a better job providing and performing recommended treatments and procedures, so did racial and ethnic equity. Nine major disparities evident in 2005 had mostly or totally disappeared by the end of 2010.
“This is happening because hospitals that disproportionately serve minority patients improved faster, and it’s also the case that individual hospitals are delivering more equal care to white and minority patients over time,” said lead author Amal Trivedi, M.D., M.P.H., an associate professor in Brown University’s School of Public Health and a hospitalist at the Providence Veterans Affairs Medical Center.
Widespread evidence remains for racial, ethnic and socioeconomic disparities in medicine, Dr. Trivedi acknowledged, noting that the results of his team’s analysis, while very positive, address only a narrow spectrum of care delivery. But they suggest that when hospitals strive to improve quality, they can improve equity.
Using data publicly reported to CMS through the Inpatient Quality Reporting Program, the team looked at the performance rates by race and ethnicity for 17 procedures that are recommended to improve patient outcomes, such as giving an aspirin to heart attack patients, a flu vaccination to pneumonia patients or clearing a blood clot in an artery of heart attack patients within 90 minutes.
The overall range of improvements was between 3.4 and 58.3 percentage points. At the beginning of 2005, there were nine metrics – three among blacks and six among Hispanics – for which there were white vs. minority gaps greater than five percentage points. By 2010 all the gaps had narrowed significantly. Gaps between blacks and whites tightened by 8.5 to 11.8 percentage points. Disparities between whites and Hispanics narrowed by 6.2 to 15.1 percentage points.
Dr. Trivedi noted that hospitals self-report this data, which has become tied to their federal compensation. Federal authorities have audited the veracity of some, but not all, of it.
Quality and Equity of Care in U.S. Hospitals, Amal N. Trivedi, M.D., M.P.H., Wato Nsa, M.D., Ph.D., Leslie R.M. Hausmann, Ph.D., Jonathan S. Lee, M.D., Allen Ma, Ph.D., Dale W. Bratzler, D.O., M.P.H., Maria K. Mor, Ph.D., Kristie Baus, R.N., Fiona Larbi, R.N., and Michael J. Fine, M.D., DOI: 10.1056/NEJMsa1405003, published 11 December 2014.
This research was funded by CMS contract HHSM-500-2011-OK10C.
Source: University of Pittsburgh School of Medicine