Gray B, Mitchell S, Horowitz E, Schlesinger M; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 1292.
The New York Academy of Medicine, Health & Science Policy, 1216 Fifth Avenue, New York, NY 10029 Tel. 212.822.7287 Fax 212.822.7369
RESEARCH OBJECTIVE: This project addresses a largely unexamined source of racial/ethnic disparities in health services and outcomes--the use of providers of different quality. Specifically the study examines racial/ethnic disparities in the use of high-volume hospitals (HVHs) for 22 procedures and conditions for which a positive volume-outcome relationship has been documented in prior research. We examine patient characteristics (insurance status, education, proximity) that may explain such disparities and whether the disparities are mitigated by managed care and public policies that concentrate care in fewer institutions. STUDY DESIGN: The study examines racial/ethnic disparities in the use of high-volume hospitals among residents of New York City and adjacent counties. High volume is defined by available threshold standards published by AHRQ and the LeapFrog Group or by alternative measures such as top decile or quartile. Logistic regression analysis is used to determine the amount of disparities between Whites, Blacks, and Hispanics in the use of HVHs, controlling for patient characteristics including insurance status, co-morbidities, proximity to a HVH, and education (measured at census tract). Separate models are estimated for each procedure and condition. POPULATION STUDIED: Data come from NYs Statewide Planning and Research Cooperative System (SPARCS) in-patient discharge records. The patients included in the study will consist of residents of NYC and adjacent NY counties who were treated in a NY hospitals 2001 or 2002 for the procedures and conditions included in the study. PRINCIPAL FINDINGS: In preliminary analyses, we found that Whites were about twice as likely as African-Americans to have their carotid endarterectomy done at a HVH. Patients of other racial/ethnic groups were also substantially less likely than Whites to use a HVH. Whites were also twice as likely as African-Americans to use a HVH for cancer surgery. Differences with the other ethnic groups were smaller. These effects remain stable even after uninsured persons were excluded. For the presentation at AcademyHealth, we will have results for the full analysis of results for 22 procedures/conditions, with appropriate statistical controls as mentioned earlier. We will also examine whether disparities are smaller for HMO enrollees and for procedures concentrated in fewer institutions. CONCLUSIONS: Our analyses are still underway, so we do not offer conclusions at this time. However, there are striking differences in the racial/ethnic composition of the patient population of hospitals in NYC. The volume-outcome literature suggests that the hospital used affects outcomes for many procedures and conditions. Racial/ethnic differences in the use of high-volume hospitals have not been previously identified as a source of disparities in services and outcomes. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Our findings will contribute to the goal of reducing racial/ethnic disparities in quality. First, the findings will provide empirical evidence of a heretofore unrecognized source of disparities in care. Documenting its dimensions is a first step toward a solution. Second, our data analysis strategy is defined in policy-relevant terms. That is, we are planning our data analysis to shed light on (a) causes of the problem and (b) the feasibility of different approaches to solution.
Publication Types:
Keywords:
- African Americans
- African Continental Ancestry Group
- Delivery of Health Care
- Ethnic Groups
- European Continental Ancestry Group
- Hispanic Americans
- Hospitals
- Humans
- Insurance Coverage
- Managed Care Programs
- Medically Uninsured
- New York City
- Population Groups
- economics
- methods
- utilization
- hsrmtgs
UI: 103624326
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