Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

1035 — Where Do Black Veterans Receive Hospital Care? Variability in Disparities within the VA Healthcare System

Jha AK (VA Boston Healthcare System) , Stone R (CHERP Pittsburgh VA), Lave J (CHERP Pittsburgh VA), Chen H (CHERP Pittsburgh VA), Klusartiz H (CHERP Philadelphia VA), Volpp KG (CHERP Philadelphia VA)

Objectives:
Racial disparities in care are well documented although their reasons are not fully understood. Research in non-VA settings suggests higher mortality rates in hospitals with a large proportion of black patients. We sought to determine whether mortality rates or racial disparities in outcomes were also higher in VA hospitals that disproportionately cared for black veterans.

Methods:
We ranked VA hospitals by the number of Blacks discharged in 2002 and identified hospitals that cumulatively cared for 25% and 75% of all black veterans. We examined the characteristics of hospitals that disproportionately cared for Blacks and determined 30-day mortality rates for six common medical conditions: pneumonia, acute myocardial infarction (AMI), congestive heart failure (CHF), gastrointestinal bleeding, hip fracture, and stroke. We used random effects models to assess the degree of variability in outcomes across hospitals.

Results:
Just 9 VA hospitals cared for 25% of all hospitalized black veterans in 2002 and 42 facilities (28% of all VA hospitals) cared for 75% of black veterans. These 42 minority-serving facilities were more often major teaching hospitals (83% versus 37%, p<0.01) and had available advanced procedures such as angioplasty (68% versus 38%, p<0.01) than other hospitals. Age- and comorbidity adjusted 30-day mortality did not vary by hospital subgroup for any of the six conditions (p>0.12 for each). For example, AMI mortality rates among veterans >65 were 15.1% versus 14.9% among minority-serving and non-minority-serving hospitals respectively. Results were similar for black-white differences in mortality across hospitals. For example, elderly Blacks with AMI had 20% lower odds of death in minority-serving hospitals and 18% lower odds of death in non-minority serving hospitals.

Implications:
Hospital care for black veterans is very concentrated: 28% of hospitals care for 75% of Blacks and 9 hospitals care for 1 in 4 Blacks. The striking lack of variation in overall outcomes and racial disparities across hospitals suggests uniformity in care within the VA not found in the private sector.

Impacts:
Future programs to improve care for black veterans can focus on a small number of hospitals, although uniformity in care suggests no easy target to better hospital care for our veterans.