Racial, Ethnic, and Socioeconomic Disparities in Estimates of AHRQ Patient Safety Indicators

U.S. Department of Health and Human Services, Washington, Washington, D.C., United States
Medical Care (Impact Factor: 3.23). 04/2005; 43(3 Suppl):I48-57. DOI: 10.1097/00005650-200503001-00008
Source: PubMed


Patient safety events that result from the happenstance of mistakes and errors should not occur systematically across racial, ethnic, or socioeconomic subgroups.
To determine whether racial and ethnic differences in patient safety events disappear when income (a proxy for socioeconomic status) is taken into account.
This study analyzes administrative data from community hospitals in 16 states with reliable race/ethnicity measures in the 2000 Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality (AHRQ), using the publicly available AHRQ patient safety indicators (PSIs).
Different indicators show different results for different racial/ethnic subgroups. Many events with higher rates for non-Hispanic blacks (compared with non-Hispanic whites) remain higher when income is taken into account, although such differences for Hispanics or Asian/Pacific Islanders (APIs) tend to disappear. Many events with lower rates for Hispanics and APIs remain lower than whites when income is taken into account, but for blacks, they disappear.
The higher rates for minorities that reflect the way health care is delivered raise troubling questions about potential racial/ethnic bias and discrimination in the US health care system, problems with cultural sensitivity and effective communication, and access to high-quality health care providers.
The AHRQ PSIs are a broad screen for potential safety events that point to needed improvement in the quality of care for specific populations.

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    • "Finally, neither ethnicity nor race was included in any models. Although both have been demonstrated to be associated with greater rates of inpatient safety indicators in studies in adult populations [59], associations with poorer health outcomes in paediatric studies have not been demonstrated [60]. If hospital care is equitable, the incidence of nursing-sensitive outcomes should not vary between racial or ethnic groups and this warrants further research. "
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    ABSTRACT: Research into nursing-sensitive outcomes using administrative health data has focussed on hospitalised adults. However, we developed algorithms for the identification of 13 paediatric nursing-sensitive outcomes, which we seek to examine for clinical utility. The aims were to determine the rates of paediatric nursing-sensitive outcomes in a Western Australian hospital and ascertain sociodemographic and clinical characteristics associated with a greater risk of developing nursing-sensitive outcomes in hospitalised children. A retrospective cohort study used linked administrative data of all Western Australian children <=18 years admitted to the only tertiary paediatric hospital in Perth between 1999 and 2009. Rates per 1,000 hospital separations and per 10,000 patient days were calculated for the following nursing-sensitive outcomes: lower respiratory tract infection (LRTI), gastrointestinal (GI) infection, pneumonia, sepsis, arrest/shock/respiratory failure, central nervous system complication, central venous line infection, infectious disease, pressure ulcer, failure to rescue, surgical wound infection, physiologic/metabolic derangement, and postoperative cardiopulmonary complications. Poisson multiple regression models were fitted to estimate rate ratios (RR) and 95% confidence intervals (CI) for suspected risk factors. Linked records of 129,719 hospital separations were analysed. Rates ranged from 0.5/1,000 for pressure ulcer to 14.0/1,000 hospital separations for GI infections. Age was significantly associated with the risk of a nursing-sensitive outcome: compared with adolescents, toddlers had greater risk of GI infection (RR 9.89; 95% CI 6.24, 15.69); infants had 7.74 times greater risk of LRTI (95% CI 5.11, 11.75), while neonates had lower risks for sepsis (RR 0.26; 95% CI 0.08, 0.90) and physiologic/metabolic derangement (RR 0.12; 95% CI 0.04, 0.35). The risk of surgical wound infection was 7.78 times greater (95% CI 5.10, 11.86) for emergency admissions than elective admissions. Seven of the 13 defined nursing-sensitive outcomes occurred with sufficient frequency (>100 events over the 10 year study period) to be potentially useful for monitoring the quality of nursing care. These nursing-sensitive outcomes are: LRTI, GI infection, pneumonia, surgical wound infection, physiologic/metabolic derangement, sepsis and postoperative cardiopulmonary complications. When used for quality improvement or to benchmark with other agencies, data need to be adjusted for, or stratified by age and admission type, to ensure equitable comparisons.
    Full-text · Article · Oct 2013 · BMC Health Services Research
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    • "Examples include the Medical Expenditure Panel Survey (MEPS) (Kirby, Taliaferro, and Zuvekas 2006; Cook, McGuire, and Zuvekas 2009a), the National Latino and Asian American Survey (Alegria et al. 2008), the National Epidemiologic Survey on Alcohol and Related Conditions (Blanco et al. 2007), Healthcare Cost and Utilization Project (Coffey, Andrews, and Moy 2005 "
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    ABSTRACT: To review methods of measuring racial/ethnic health care disparities. Identification and tracking of racial/ethnic disparities in health care will be advanced by application of a consistent definition and reliable empirical methods. We have proposed a definition of racial/ethnic health care disparities based in the Institute of Medicine's (IOM) Unequal Treatment report, which defines disparities as all differences except those due to clinical need and preferences. After briefly summarizing the strengths and critiques of this definition, we review methods that have been used to implement it. We discuss practical issues that arise during implementation and expand these methods to identify sources of disparities. We also situate the focus on methods to measure racial/ethnic health care disparities (an endeavor predominant in the United States) within a larger international literature in health outcomes and health care inequality. EMPIRICAL APPLICATION: We compare different methods of implementing the IOM definition on measurement of disparities in any use of mental health care and mental health care expenditures using the 2004-2008 Medical Expenditure Panel Survey. Disparities analysts should be aware of multiple methods available to measure disparities and their differing assumptions. We prefer a method concordant with the IOM definition.
    Full-text · Article · Feb 2012 · Health Services Research
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    • "Future studies should explore why hospitals serving higher proportions of Hispanic patients, and in some cases black patients, had lower rates for a specific PSI. Coffey, Andrews, and Moy (2005) found similar disadvantages and advantages for black and Hispanic patients. Similar to other studies regarding AMI care, we found that minority patients used lower-performing hospitals for AMI (Bradley et al. 2004; Barnato et al. 2005; Hasnain-Wynia et al. 2007; Skinner et al. 2005). "
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    ABSTRACT: Employing three years of inpatient discharge data from 11 states and inpatient and patient safety quality indicators from the Agency for Healthcare Research and Quality (AHRQ), this paper explored whether minority (black, Hispanic, and Asian) patients used lower quality hospitals. We found that the association between the share of minority patients and hospital quality depended on how quality was measured and varied by race and ethnicity. Hospitals serving Hispanics performed well on most patient safety measures. Higher percentages of all three minority patient groups corresponded to lower quality for only one measure, postoperative sepsis. Our analysis indicates that it is incorrect to generalize that minorities use lower quality hospitals. Analysts and policymakers should be cautious when making generalizations about the overall service quality of hospitals that treat minority patients.
    Full-text · Article · Sep 2011 · Inquiry: a journal of medical care organization, provision and financing
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