Impact of race on health care utilization and outcomes in veterans with congestive heart failure.
OBJECTIVE
The objectives of this study were to determine racial differences in mortality in a national cohort of patients hospitalized with congestive heart failure (CHF) within a financially "equal-access" healthcare system, the Veterans Health Administration (VA), and to examine racial differences in patterns of healthcare utilization following hospitalization.


BACKGROUND
To explain the observed paradox of increased readmissions and lower mortality in black patients hospitalized with CHF, it has been postulated that black patients may have reduced access to outpatient care, resulting in a higher number of hospital admissions for lesser disease severity.


METHODS
In a retrospective study of 4,901 black and 17,093 white veterans hospitalized with CHF in 153 VA hospitals, we evaluated mortality at 30 days and 2 years, and healthcare utilization in the year following discharge.


RESULTS
The risk-adjusted odds ratios (OR) for 30-day and 2-year mortality in black versus white patients were 0.70 (95% confidence interval [CI] 0.60 to 0.82) and 0.84 (95% CI 0.78 to 0.91), respectively. In the year following discharge, blacks had the same rate of readmissions as whites. Blacks had a lower rate of medical outpatient clinic visits and a higher rate of urgent care/emergency room visits than whites, although these differences were small.


CONCLUSIONS
In a system where there is equal access to healthcare, the racial gap in patterns of healthcare utilization is small. The observation of better survival in black patients after a CHF hospitalization is not readily explained by differences in healthcare utilization.
Deswal
Anita
A
Houston Center for Quality of Care and Utilization Studies, Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas 77030, USA. adeswal@bcm.tmc.edu
Petersen
Nancy J
NJ
Souchek
Julianne
J
Ashton
Carol M
CM
Wray
Nelda P
NP
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility; D006333:Heart Failure / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014600:Utilization Review; D014728:Veterans / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*