title: Race, resource use, and survival in seriously ill hospitalized adults. The SUPPORT Investigators.
abstract: OBJECTIVE
  To examine the association between patient race and hospital resource use.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Five geographically diverse teaching hospitals.
  
  
  METHODS
  Patients were 9,105 hospitalized adults with one of nine illnesses associated with an average 6-month mortality of 50%.
  
  
  RESULTS
  Measures of resource use included: a modified version of the Therapeutic Intervention Scoring System (TISS); performance of any of five procedures (operation, dialysis, pulmonary artery catheterization, endoscopy, and bronchoscopy); and hospital charges, adjusted by the Medicare cost-to-charge ratio per cost center at each participating hospital. The median patient age was 65; 79% were white, 16% African-American, 3% Hispanic, and 2% other races; 47% died within 6 months. After adjusting for other sociodemographic factors, severity of illness, functional status, and study site, African-Americans were less likely to receive any of five procedures on study day 1 and 3 (adjusted odds ratio [OR] 0.70; 95% confidence interval [CI] 0.60, 0.81). In addition, African-Americans had lower TISS scores on study day 1 and 3 (OR -1.8; 95% CI-1.3, -2.4) and lower estimated costs of hospitalization (OR (-)$2,805; 95% CI (-)$1,672, (-)$3,883). Results were similar after adjustment for patients' preferences and physicians' prognostic estimates. Differences in resource use were less marked after adjusting for the specialty of the attending physician but remained significant. In a subset analysis, cardiologists were less likely to care for African-Americans with congestive heart failure (p < .001), and cardiologists used more resources (p < .001). After adjustment for other sociodemographic factors, severity of illness, functional status, and study site, survival was slightly better for African-American patients (hazard ratio 0.91; 95% CI 0.84, 0.98) than for white or other race patients.
  
  
  CONCLUSIONS
  Seriously ill African-Americans received less resource-intensive care than other patients after adjustment for other sociodemographic factors and for severity of illness. Some of these differences may be due to differential use of subspecialists. The observed differences in resource use were not associated with a survival advantage for white or other race patients.
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Hospital, Boston, Mass 02215, USA.
authors.forename: R S
authors.initials: RS
authors.lastname: Phillips
authors.forename: M B
authors.initials: MB
authors.lastname: Hamel
authors.forename: J M
authors.initials: JM
authors.lastname: Teno
authors.forename: P
authors.initials: P
authors.lastname: Bellamy
authors.forename: S K
authors.initials: SK
authors.lastname: Broste
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
authors.forename: H
authors.initials: H
authors.lastname: Vidaillet
authors.forename: R B
authors.initials: RB
authors.lastname: Davis
authors.forename: L H
authors.initials: LH
authors.lastname: Muhlbaier
authors.forename: A F
authors.initials: AF
authors.lastname: Connors
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006297:Health Services Accessibility / Q000639:trends*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D015996:Survival Rate; D019452:Terminally Ill; D014481:United States