- Hospitals generally provide similar levels of quality care to individuals across socioeconomic groups, indicating that outcomes disparities may be rooted in external community factors, according to a recent study published in JAMA.
While the healthcare industry has worked to achieve health equity among all patients, disparities still exist. Because hospitals play a critical role in influencing patient outcomes, the researchers wanted to know whether hospital performance varies depending on patients’ race or socioeconomic status.
The team analyzed Medicare claims data to determine differences in outcomes for acute myocardial infarction (AMI), heart failure (HF), and pneumonia within and between hospitals.
Researchers found that for all three conditions, black patients had lower 30-day risk-standardized mortality rates (RSMRs) than white patients treated at the same hospital. However, risk-standardized readmission rates (RSRRs) were higher for black patients for all three conditions.
While there were intrahospital differences in both mortality rates and readmissions between black patients and white patients, the differences were relatively small.
The intraclass correlation (ICC) of mortality ratios by race were 0.68 for AMI, 0.72 for HF, and 0.70 for pneumonia. The data indicates that hospitals that produced low mortality ratios for white patients also produced low ratios for black patients.
For readmissions, hospital performance was especially consistent, with intraclass correlations (ICCs) of 0.73 for AMI, 0.73 for HF, and 0.79 for pneumonia.
Researchers also found that while there were small differences in RSMRs and RSRRs among income groups, with patients from lower-income groups appearing to experience slightly worse outcomes, the differences were not significant.
The team then compared mortality and readmission rates at different hospitals.
Researchers grouped hospitals into deciles according to the number of black patients treated for each condition. The group found that RSMRs for both whites and blacks were generally consistent across deciles.
Although there were significant variations in RSRRs between hospitals, the results show that these variations are not associated with the proportion of black patients admitted to each hospital.
When comparing outcomes in terms of socioeconomic status, the researchers determined that there was no association between the proportion of lower-income patients and hospitals’ overall RSMRs.
Comparisons of RSRRs between hospitals did not show a strong association with the proportion of lower-income patients admitted to each hospital.
The results show that there is relatively consistent performance within and between hospitals, suggesting that health outcome disparities are the result of wider societal differences that affect all organizations.
“The interpretation is that hospital performance for white patients, relative to the performance of other hospitals for white patients, is similar to hospital performance for black patients, relative to other hospitals’ performance for black patients,” the team said.
“Thus, the difference in rates by race appears to be a systemic issue, rather than localized to certain hospitals that perform differently for patients of different races.”
The researchers note that the study does have limitations, such as the fact that it excluded almost three-quarters of hospitals because they lacked sufficient diversity in their patient populations.
Still, the team believes that their results indicate that to overcome health outcome disparities, leaders must look beyond the performance of healthcare organizations to other external factors that may affect patients’ health.
“We found evidence that differences in the performance of hospitals in the United States according to patients’ race and neighborhood-income level may be systemic,” the group concluded.
“Consequently, initiatives seeking to address these differences likely will require far-reaching interventions in and out of the healthcare system.”