How do black-serving hospitals perform on patient safety indicators? Implications for national public reporting and pay-for-performance.
BACKGROUND
There is increasing policy interest in public reporting and tying financial incentives to metrics of patient safety. How black-serving hospitals fare on these measures will have important implications for disparities in care.


OBJECTIVE
To determine how black-serving hospitals perform on patient safety indicators (PSIs).


METHODS
We used national Medicare data to calculate the performance of hospitals on 11 medical and surgical PSIs. We designated US hospitals in the top decile of proportion of hospitalized patients who are black as "black-serving." We calculated overall and race-specific rates and examined the relationship between being a black-serving hospital and PSI rates.


METHODS
Medicare fee-for-service enrollees discharged from 4488 acute-care US hospitals.


RESULTS
Black-serving hospitals performed worse than other hospitals on 6 of 11 PSIs. For example, black-serving hospitals had nearly twice the rate of postoperative pulmonary embolism or deep venous thrombosis (19.4 vs. 11.5 per 1000 discharges, P < 0.001). Adjusting for hospital characteristics had moderate effects. In race-specific analyses, we found that both white and black patients generally had higher rates of potential safety events in black-serving hospitals than they did in non-black-serving hospitals.


CONCLUSIONS
Hospitals that disproportionately care for black patients have higher rates of potential safety events among both black and white patients than other hospitals. Current efforts to penalize hospitals with high PSI rates will have a greater effect on hospitals that disproportionately care for black patients.
Harvard Kennedy School, Cambridge, MA 02138, USA. dan_ly@hks11.harvard.edu
Dan P
DP
Ly
Lenny
L
Lopez
Thomas
T
Isaac
Ashish K
AK
Jha
D044383:Black People / Q000706:statistics & numerical data*; D003428:Cross Infection / Q000208:ethnology; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006753:Hospital Records / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D018410:Pneumonia, Bacterial / Q000208:ethnology; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D017751:Safety Management / Q000706:statistics & numerical data*; D018805:Sepsis / Q000208:ethnology; D014481:United States / Q000453:epidemiology; D001741:Black or African American