title: Disparities in the utilization of high-volume hospitals for total hip replacement.
abstract: OBJECTIVE
  Higher hospital surgical volumes have been associated with lower complication rates following total-hip replacement. The objective of this study was to identify the characteristics of patients who undergo total-hip replacement at high-volume hospitals and their differences from those who receive care at low-volume hospitals.
  
  
  METHODS
  Discharge data from patients undergoing total hip replacement in California from 1995 to 2005 were analyzed. Hospitals were classified into 3 tiers of low, intermediate, or high surgical volume. The relationships between race/ethnicity and income to utilization of low-volume and high-volume hospitals were examined by creating logistic regression models that include patient covariates such as age, gender, and comorbidity.
  
  
  RESULTS
  This study analyzed 138399 cases of primary total-hip replacements during the study period. Patients of Hispanic ethnicity, or black or Asian race had higher relative risk ratios for being treated at a low-volume center compared to white patients.
  
  
  CONCLUSIONS
  There are disparities in the characteristics of patients receiving care at hospitals performing a high volume or low volume of total-hip replacements. Hispanic ethnicity, and black and Asian race were statistically significant predictors of utilization of a low-volume hospital.
authors.affiliation: Department of Orthopaedic Surgery, University of California Los Angeles, 10945 Le Conte Ave., PVUB #3355, Los Angeles, CA 90095, USA. nsoohoo@mednet.ucla.edu
authors.forename: Nelson F
authors.initials: NF
authors.lastname: SooHoo
authors.forename: Eugene
authors.initials: E
authors.lastname: Farng
authors.forename: David S
authors.initials: DS
authors.lastname: Zingmond
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000191:economics / Q000706:statistics & numerical data*; D002140:California; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data