Process of care in Hispanic, black, and white VA beneficiaries.
OBJECTIVE
To examine whether process of hospital care differs among Hispanic, black, and white VA beneficiaries.


METHODS
Two thousand eight-hundred fifty-two Hispanic, black, and white male VA beneficiaries from a case-control study discharged alive from one of twelve southern veterans hospitals with one of three diagnoses, diabetes mellitus (DM), congestive heart failure (CHF), or chronic obstructive pulmonary disease (COPD).


METHODS
We applied diagnosis-specific explicit criteria for the process of hospital care to each patient's hospital record and computed the adherence score; the percentage of applicable criteria performed during the hospital stay. We compared mean scores in Hispanic, black, and white patients and then compared adjusted scores using multiple linear regression.


METHODS
Process of inpatient care (adherence score) in Hispanic, black, and white patients at admission, treatment, and discharge.


RESULTS
Mean admission adherence scores differed (P = 0.003) among Hispanic patients, black patients, and white patients for CHF and COPD, but not DM. Mean treatment and discharge scores were not different among Hispanic patients, black patients, and white patients. In bivariate comparisons, mean admission scores were higher in black patients compared with white patients for CHF (P= 0.003) and COPD (P= 0.01). In stratified analyses, admission and treatment scores were higher (P= 0.0001) in patients admitted to teaching compared with nonteaching hospitals. Process of inpatient care did not differ among Hispanic, black, and white patients after adjusting for admission to a teaching hospital and other covariates.


CONCLUSIONS
In contrast to findings in other studies, process of inpatient care was generally similar in Hispanic patients, black patients, and white patients. Our findings may reflect several characteristics of veterans' hospitals that may lead to care that is more equitable.
Gordon
Howard S
HS
Houston Center for Quality of Care and Utilization Studies, Section of General Medicine, Veterans Affairs Medical Center, TX, USA. hgordon@bcm.tmc.edu
Johnson
Michael L
ML
Ashton
Carol M
CM
D001741:Black or African American / Q000706:statistics & numerical data*; D000704:Analysis of Variance; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000628:therapy; D006333:Heart Failure / Q000628:therapy; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans; D006801:Humans; D016014:Linear Models; D008297:Male; D017064:Process Assessment, Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy; D011787:Quality of Health Care; D014481:United States; D014728:Veterans; D044465:White People / Q000706:statistics & numerical data*