title: Technology diffusion, hospital variation, and racial disparities among elderly Medicare beneficiaries: 1989-2000.
abstract: BACKGROUND
  Low rates of technology utilization in hospitals with high proportions of black inpatients may be a remediable cause of healthcare disparities.
  
  
  OBJECTIVE
  Our objective was to determine how differences in technology utilization among hospitals contributed to racial disparity and if temporal reduction in hospital procedure rate variation resulted in decreased racial disparity for these technologies.
  
  
  METHODS
  We identified 2,348,952 elderly Medicare beneficiaries potentially eligible for 1 of 5 emerging medical technologies from 1989-2000 and determined if these patients had received the indicated procedure within 90 days of their qualifying hospital admission. Initial multivariate regression models adjusted for age, race, sex, admission year, clinical comorbidity, community levels of education and income, and academic/urban hospital admission. The inpatient racial composition of each patient's admitting hospital and time-race interactions were added as covariates to subsequent models.
  
  
  RESULTS
  Blacks had significantly lower adjusted rates (P < 0.001) compared with whites for tissue replacement of the aortic valve, internal mammary artery coronary bypass grafting, dual-chambered pacemaker implantation, and lumbar spinal fusion. Hospitals with > 20% black inpatients were less likely to perform these procedures on both white and black patients than hospitals with < 9% black inpatients, and racial disparity was greater in hospitals with larger black populations. There were no temporal reductions in racial disparities.
  
  
  CONCLUSIONS
  Blacks may be disadvantaged in access to new procedures by receiving care at hospitals that have both lower procedure rates and greater racial disparity. Policies designed to ameliorate racial disparities in health care must address hospital variation in the provision of care.
authors.affiliation: Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA. peter.groeneveld@med.va.gov
authors.forename: Peter W
authors.initials: PW
authors.lastname: Groeneveld
authors.forename: Sara B
authors.initials: SB
authors.lastname: Laufer
authors.forename: Alan M
authors.initials: AM
authors.lastname: Garber
mesh_terms: D000368:Aged; D019985:Benchmarking; D020811:Biomedical Technology / Q000706:statistics & numerical data*; D044383:Black People / Q000706:statistics & numerical data; D015331:Cohort Studies; D004059:Diffusion of Innovation; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014600:Utilization Review; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American