title: Are there race/ethnicity differences in outpatient congestive heart failure management, hospital use, and mortality among an insured population?
abstract: OBJECTIVE
  The objective of this study was to assess the quality of outpatient care received by patients with congestive heart failure (CHF) and whether differences in care and outcomes exist by race/ethnicity.
  
  
  BACKGROUND
  Appropriate outpatient CHF management can improve patient well-being and reduce the need for costly inpatient care. Yet, little is known regarding outpatient CHF management or whether differences in this care exist by race/ethnicity.
  
  
  METHODS
  Using automated data sources, we identified a cohort of insured patients seen in an outpatient setting for CHF between September 1992 and August 1993. Medical record abstraction was used to confirm diagnosis of CHF. Patients (N = 566) were followed until September 1998. Race/ethnicity differences in outpatient management and medical care utilization were assessed using generalized estimating equations. Differences in mortality and hospitalization for CHF, controlling for patient characteristics and outpatient management, were assessed using Cox and Andersen-Gill models, respectively.
  
  
  RESULTS
  With the exception of beta blocker use and primary care visit frequency, few differences by race/ethnicity in patient characteristics and CHF management were found. However, older black patients had more hospital use both at baseline and during follow up. These differences persisted after adjusting for patient characteristics and clinical management. No race/ethnicity differences were found in mortality.
  
  
  CONCLUSIONS
  In an insured population, older black patients with CHF have substantially more hospital use than older white patients. This increased use was not explained by differences in CHF outpatient management. Further research is needed to understand why race/ethnicity differences in hospital use are observed among older patients with CHF.
authors.affiliation: Department of Biostatistics & Research Epidemiology, Henry Ford Health System, Detroit, Michigan 48202, USA. JLAFATA1@hfhs.org
authors.forename: Jennifer Elston
authors.initials: JE
authors.lastname: Lafata
authors.forename: Manel
authors.initials: M
authors.lastname: Pladevall
authors.forename: George
authors.initials: G
authors.lastname: Divine
authors.forename: Melissa
authors.initials: M
authors.lastname: Ayoub
authors.forename: Edward F
authors.initials: EF
authors.lastname: Philbin
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000553:Ambulatory Care / Q000592:standards / Q000706:statistics & numerical data*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006279:Health Maintenance Organizations / Q000592:standards / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015146:Midwestern United States / Q000453:epidemiology; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011787:Quality of Health Care; D016019:Survival Analysis; D044465:White People / Q000706:statistics & numerical data*