Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3082 — Are Minorities At Higher Risk of Patient Safety Events in the VA?

Shimada SL (COE Bedford) , Montez-Rath ME (COE Bedford), Loveland SA (COE Bedford), Zhao S (COE Bedford), Kressin NR (COE Bedford), Rosen AK (COE Bedford)

Objectives:
Minorities often experience reduced access to care, poorer quality of care, and worse outcomes. Contrary to the private sector, there is evidence within VA that quality of care does not differ by race or may even be better for minorities. Little is known about whether patient safety events, markers of potential poor quality of care, occur disproportionately across different racial/ethnic groups. We examined whether there are racial/ethnic disparities in the incidence of AHRQ’s Patient Safety Indicators (PSIs) within VA.

Methods:
We calculated PSI events from FY2000-FY2005 VA discharge data for 128 acute-care hospitals (N=2,281,286 hospitalizations). To determine whether race was significantly associated with the likelihood of a PSI event, we ran logistic regression models for fifteen PSIs, controlling for patient age, gender, comorbidities, and clustering at the hospital level.

Results:
The odds of decubitus ulcer (OR=1.36, 95%CI [1.20,1.53]) and postoperative pulmonary embolism and deep vein thrombosis (PE/DVT) (OR=1.23, 95%CI [1.13,1.35]) were higher for African-Americans than for Whites. In contrast, African-Americans had significantly lower odds than Whites for 3 PSIs: complications of anesthesia (OR=0.63, 95%CI [0.43,0.92]), postoperative wound dehiscence (OR=0.72, 95%CI [0.53,0.98]), and accidental puncture/laceration (OR=0.71, 95%CI [0.59,0.86]). Latinos also had significantly higher odds of decubitus ulcer (OR=1.65, 95%CI [1.05,2.60]) but had significantly lower odds of postoperative hemorrhage/hematoma (OR=0.71, 95%CI [0.52,0.97]) compared with Whites. Asians had significantly higher odds for complications of anesthesia (OR=2.19, 95%CI [1.03,4.67]), and Native Americans had higher odds of postoperative hip fracture (OR=3.98, 95%CI[1.06,15.00]) and postoperative respiratory failure (OR=1.80, 95%CI [1.04,3.12]) compared with Whites. No significant racial/ethnic differences were found for the remaining 7 PSIs.

Implications:
The risk of PSI events varied across racial/ethnic subgroups. Many PSIs showed no significant differences across race/ethnicity and the differences found were both positive and negative for minorities. However, two high-frequency PSI events (decubitus ulcer and postoperative PE/DVT) were more likely to occur in minorities.

Impacts:
The AHRQ PSIs help target specific areas for quality improvement. Initiatives targeting decubitus ulcer and PE/DVT are needed to improve quality of care for minority populations and for veterans overall. Future research should examine patient- and hospital-level factors that might explain the variation in PSI events across racial/ethnic groups in VA.