Health care disparities more about where care is delivered

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The latest issue of Health Affairs focusing on Disparities: Expanding the Focus includes almost two dozen articles on the subject. Two that stand out examine racial and ethnic disparities in the quality of hospital care. The first, D. Gaskin, et. al., Do Hospitals Provide Lower Quality Care to Minorities than to Whites? studied outcomes of care within hospitals across racial/ethnic lines. The short answer is no – minority patients receive the same standard of care that white patients in the same hospital receive. The authors comment, “Perhaps we are looking in the wrong place . . . we may have to follow patients out of the hospitals and look at look at other health outcomes measures – for example, rates of death within seven, thirty and ninety days or readmission due to complications.”

This research builds on previous research that suggests that the basis of disparities is more about the location of care. A second article, A. Jha, et. al., The Characteristics and Performance of Hospitals that Care for Elderly Hispanics, addresses this question. The authors, from Harvard, looked at the 5% of US hospitals (227 of them) that care for more than half of American elderly Hispanic patients. They found these hospitals were more likely to be for-profit, with higher Medicaid caseloads and low nurse-staffing levels. These hospitals provided slightly lower quality care for heart attacks/disease and pneumonia, compared to national and regional averages, and were less likely to have cardiac and medical ICUs. The good news may be that improving disparities in quality of care could involve focusing on a limited number of sites.
Ellen Andrews