Concentration and quality of hospitals that care for elderly black patients.
BACKGROUND
The reasons for racial differences in health care are not well known, but the characteristics of hospitals where people receive care may be an important factor in the quality of care that patients receive. Therefore, we sought to determine the proportion and volume of elderly black vs white patients treated at hospitals and examine the characteristics and performances of hospitals that care for disproportionately high volumes of black patients.


METHODS
We used 2004 Medicare data to calculate, for each hospital in our study, the volume and proportion of black patients discharged. We then examined the hospitals' structural characteristics and performances according to quality measures for patients with acute myocardial infarction, congestive heart failure, and pneumonia.


RESULTS
The 5% of hospitals with the highest volume of black patients cared for nearly half of all elderly black patients, and the hospitals in the top quartile by volume of patients cared for nearly 90% of elderly black patients. Hospitals with a high volume of black patients were larger and were more often teaching hospitals located in the southern United States (P<.001 for each comparison) than those with a low volume of black patients. Hospitals with a high proportion of black patients had comparable characteristics. After adjusting for hospital characteristics, hospitals that treated a high vs low volume of black patients had worse performance summary scores for acute myocardial infarction (89.0 vs 90.7; P = .002) and pneumonia measures (76.9 vs 79.4; P<.001). Adjusting for hospital referral region eliminated the gap in performance scores for acute myocardial infarction but not for pneumonia. There were comparable differences in performance scores for hospitals that treated a high vs low proportion of black patients.


CONCLUSIONS
Hospital care for black patients in the United States is remarkably concentrated in a small percentage of hospitals, although the hospitals that care for a high proportion of black patients have only marginally worse quality of care than those that care for a low proportion of black patients. The level of concentration of black patients provides a fresh opportunity to improve care for black patients by targeting efforts toward a small group of hospitals.
Jha
Ashish K
AK
Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass. 02115, USA.
Orav
E John
EJ
Li
Zhonghe
Z
Epstein
Arnold M
AM
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D044383:Black People; D006333:Heart Failure / Q000188:drug therapy / Q000453:epidemiology*; D006742:Hospital Bed Capacity; D006761:Hospitals; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy / Q000453:epidemiology*; D010100:Oxygen / Q000097:blood; D010351:Patient Discharge / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D011014:Pneumonia / Q000453:epidemiology* / Q000628:therapy; D011787:Quality of Health Care; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000453:epidemiology; D001741:Black or African American
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000900:Anti-Bacterial Agents; D010975:Platelet Aggregation Inhibitors; D022242:Pneumococcal Vaccines; D001241:Aspirin; D010100:Oxygen