Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

VA Health Systems Research

Go to the VA ORD website
Go to the QUERI website
2015 Conference Logo

2015 HSR&D/QUERI National Conference Abstract

3051 — Methods for measuring racial differences in hospital outcomes attributable to disparities in use of high-quality hospital care

Hebert PL, VA Puget Sound Health Care System; Wong ES, VA Puget Sound Health Care System; Hernandez SE, VA Puget Sound Health Care System; Rinne ST, VA Connecticut Healthcare System; Sulc CA, VA Puget Sound Health Care System; Neely EL, VA Puget Sound Health Care System; Liu CF, VA Puget Sound Health Care System;

To test a new approach to measuring racial/ethnic disparities in the use of high-quality hospitals.

To study disparities in the use of high-quality hospital care, researchers typically identify hospitals that are "minority-serving" and report differences in risk-adjusted outcomes between minority-serving and non-minority-serving hospitals. There are problems with this approach. First, it requires making ad hoc decisions on the definition of a minority-serving hospital. Second, disparities in outcomes between minority-serving and non-minority-serving hospitals are meaningful statistics only if a large percentage of the minority population receives care from minority-serving facilities. Third, these methods estimate disparities due to "between-hospital" differences in care quality; disparities in outcomes can also materialize if minority patients received poorer quality of care than whites at all hospitals (a "within-hospital" disparity). We proposed a new approach that estimated the reduction in outcomes if minority patients switched hospitals with white patients. Through simulations, we compared the new approach to the commonly-used "minority-serving" approach. We evaluated each method's ability to detect and measure a between-hospital disparity when the simulation imposed one. We also conducted an empirical demonstration of readmissions for heart failure in the VA or Medicare, 2006-2009.

In simulations, the commonly-used and new approaches correctly identified between-hospital disparities when they existed, and rejected them when racial differences in readmissions were caused by within-hospital disparities. The new approach estimated the magnitude of the disparity accurately; the commonly-used approach underestimated it by 36%. In the empirical analysis of 32,956 Veterans with an index hospitalization for heart failure at 125 VA hospitals, there were 186.2 (95% CI, 107.1 to 265.4) excess readmissions for African American veterans. Using the new approach we estimated that only 31 (95% CI, -3 to 65) of these could be attributed to between-hospital disparities in quality of care.

The new methods required fewer ad hoc assumptions, gave results that were pertinent to all minorities in a community, not just those at "minority-serving" facilities, and gave more accurate estimates of the magnitude of between-hospital disparities.

Researchers should consider using the new approach for measuring disparities in use of high-quality care by vulnerable populations.