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APHA Scientific Session and Event Listing

Darrell Gaskin, PhD, Christine Spencer, ScD, and Thomas A. LaVeist, PhD. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 441, Baltimore, MD 21205, 443-287-5297, dgaskin@jhsph.edu

Objective: Disparities in hospital based care have been well documented. There is some empirical evidence suggesting that disparities in the quality of hospital care are due more to variation in quality of care across hospitals than variation in quality of care within hospitals. Stated simply, minority patients receive lower quality care because they are being served by lower quality hospitals. According to prior research, minority and low income patients are distributed differently across hospitals than white and more affluent patients. Minority and low income patients are more likely to use safety net hospitals, public hospitals and major teaching hospitals. However, because these hospitals serve higher proportions of minority and low income patients they claim to have expertise in providing high quality care to these patients. For example, when Medicaid managed care threatened to shift Medicaid patients from traditional safety net hospitals, advocates for these hospitals claimed that this policy hurt Medicaid patients because it moved them from hospitals that understood the nexus of their health and social problems to hospitals that were unfamiliar with the unique challenges associated with serving these patients. In addition, studies have shown that larger, urban and teaching hospitals provide better quality of care than smaller, rural and non-teaching hospitals. Hence, these advocates would argue that hospitals that serve higher proportions of minority and low income patients provide better quality of care to them than hospitals that are unfamiliar with them.

Data Sources: We used state inpatient discharge data from 15 states: AZ, CA, CO, FL, IA, MA, MD, MI, NC, NJ, NY, PA, SC, TX and WI, and data from the AHA Annual Survey of Hospitals and Medicare Cost Reports. We used the AHRQ inpatient quality indicators and patient safety indicators to measure hospital quality.

Study Design: We computed concentration measures similar to Gini coefficients to assess whether minority and low income patients used lower quality hospitals. Hospital level regressions were estimated to identify hospital characteristics that were associated with high quality of hospital care for minority and low income patients.

Preliminary Findings: Minority and low income patients were more likely to be receive care at hospitals at the very high end and low end of the quality spectrum. A significant number of hospitals provided lower quality care to their minority and low income patients. Minority and low income patients received high quality care in hospitals that are in good financial health.

Learning Objectives:

• to understand whether disparities due to low quality hospitals or differential treatment in hospitals.
• to learn what hospital characteristics are associated with high quality care for minority and low income patients.

Keywords: Hospitals, Quality of Care

Presenting author's disclosure statement:

Not Answered