Methods for Measuring Racial Differences in Hospitals Outcomes Attributable to Disparities in Use of High-Quality Hospital Care.

Hebert PL, Howell EA, Wong ES, Hernandez SE, Rinne ST, Sulc CA, Neely EL, Liu CF. Methods for Measuring Racial Differences in Hospitals Outcomes Attributable to Disparities in Use of High-Quality Hospital Care. Health services research. 2017 Apr 1; 52(2):826-848.

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Abstract:

OBJECTIVE: To compare two approaches to measuring racial/ethnic disparities in the use of high-quality hospitals. DATA SOURCES: Simulated data. STUDY DESIGN: Through simulations, we compared the "minority-serving" approach of assessing differences in risk-adjusted outcomes at minority-serving and non-minority-serving hospitals with a "fixed-effect" approach that estimated the reduction in adverse outcomes if the distribution of minority and white patients across hospitals was the same. We evaluated each method''s ability to detect and measure a disparity in outcomes caused by minority patients receiving care at poor-quality hospitals, which we label a "between-hospital" disparity, and to reject it when the disparity in outcomes was caused by factors other than hospital quality. PRINCIPAL FINDINGS: The minority-serving and fixed-effect approaches correctly identified between-hospital disparities in quality when they existed and rejected them when racial differences in outcomes were caused by other disparities; however, the fixed-effect approach has many advantages. It does not require an ad hoc definition of a minority-serving hospital, and it estimated the magnitude of the disparity accurately, while the minority-serving approach underestimated the disparity by 35-46 percent. CONCLUSIONS: Researchers should consider using the fixed-effect approach for measuring disparities in use of high-quality hospital care by vulnerable populations.