title: Performance of racial and ethnic minority-serving hospitals on delivery-related indicators.
abstract: OBJECTIVE
  We sought to explore how racial/ethnic minority-serving hospitals perform on 15 delivery-related indicators, and examine whether indicators vary by race/ethnicity within the same type of hospitals.
  
  
  METHODS
  We used 2008 through 2011 linked State Inpatient Database and American Hospital Association data from 7 states, and designated hospitals with >50% of deliveries to non-Hispanic white, non-Hispanic black, and Hispanic women as white-, black-, and Hispanic-serving, respectively. We calculated indicator rates per 1000 deliveries by hospital type and, separately, for non-Hispanic white, non-Hispanic black, and Hispanic women within each hospital type. We fitted multivariate Poisson regression models to examine associations between delivery-related indicators and patient and hospital characteristics by hospital type.
  
  
  RESULTS
  White-serving hospitals offer obstetric care to an older and wealthier population than black- or Hispanic-serving hospitals. Rates of the most prevalent indicators examined (complicated vaginal delivery, complicated cesarean delivery, obstetric trauma) were lowest in Hispanic-serving hospitals. Generally, indicator rates were similar in Hispanic- and white-serving hospitals. Black-serving hospitals performed worse than other hospitals on 12 of 15 indicators. Indicator rates varied greatly by race/ethnicity in white- and Hispanic-serving hospitals, with non-Hispanic blacks having 1.19-3.27 and 1.15-2.68 times higher rates than non-Hispanic whites, respectively, for 11 of 15 indicators. Conversely, there were few indicator rate differences by race/ethnicity in black-serving hospitals, suggesting an overall lower performance of these hospitals compared to white- and Hispanic-serving hospitals.
  
  
  CONCLUSIONS
  We found considerable differences in delivery-related indicators by hospital type and patients' race/ethnicity. Obstetric care quality measures are needed to track racial/ethnic disparities at the facility and population levels.
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Electronic address: acreanga@cdc.gov.
authors.forename: Andreea A
authors.initials: AA
authors.lastname: Creanga
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, and Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Bateman
authors.affiliation: Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Mhyre
authors.affiliation: Division of Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Elena
authors.initials: E
authors.lastname: Kuklina
authors.affiliation: Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY.
authors.forename: Alexander
authors.initials: A
authors.lastname: Shilkrut
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: William M
authors.initials: WM
authors.lastname: Callaghan
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D017677:Age Distribution; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006761:Hospitals / Q000145:classification / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D007182:Income / Q000706:statistics & numerical data*; D008913:Minority Groups / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D058725:Peripartum Period; D016012:Poisson Distribution; D011183:Postoperative Complications / Q000453:epidemiology*; D011247:Pregnancy; D011645:Puerperal Infection / Q000453:epidemiology*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014597:Uterine Rupture / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: United States; delivery; ethnicity; quality of care; race