title: Black patients more likely than whites to undergo surgery at low-quality hospitals in segregated regions.
abstract: Research has shown that black patients more frequently undergo surgery at low-quality hospitals than do white patients. We assessed the extent to which living in racially segregated areas and living in geographic proximity to low-quality hospitals contribute to this disparity. Using national Medicare data for all patients who underwent one of three high-risk surgical procedures in 2005-08, we found that black patients actually tended to live closer to higher-quality hospitals than white patients did but were 25-58 percent more likely than whites to receive surgery at low-quality hospitals. Racial segregation was also a factor, with black patients in the most segregrated areas 41-96 percent more likely than white patients to undergo surgery at low-quality hospitals. To address these disparities, care navigators and public reporting of comparative quality could steer patients and their referring physicians to higher-quality hospitals, while quality improvement efforts could focus on improving outcomes for high-risk surgery at hospitals that disproportionately serve black patients. Unfortunately, existing policies such as pay-for-performance, bundled payments, and nonpayment for adverse events may divert resources and exacerbate these disparities.
authors.affiliation: Division of Minimally Invasive Surgery, University of Michigan, Ann Arbor, Michigan, USA. jdimick@med.umich.edu
authors.forename: Justin
authors.initials: J
authors.lastname: Dimick
authors.forename: Joel
authors.initials: J
authors.lastname: Ruhter
authors.forename: Mary Vaughan
authors.initials: MV
authors.lastname: Sarrazin
authors.forename: John D
authors.initials: JD
authors.lastname: Birkmeyer
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery; D001026:Coronary Artery Bypass / Q000401:mortality; D054625:Healthcare Disparities / Q000208:ethnology*; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery; D006278:Medicare / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D019984:Quality Indicators, Health Care; D063505:Racism / Q000208:ethnology / Q000706:statistics & numerical data; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*
keywords: Access To Care; Disparities; Minority Health; Quality Of Care