title: Methods for Measuring Racial Differences in Hospitals Outcomes Attributable to Disparities in Use of High-Quality Hospital Care.
abstract: To compare two approaches to measuring racial/ethnic disparities in the use of high-quality hospitals.
  
  
  
  Simulated data.
  
  
  
  Through simulations, we compared the "minority-serving" approach of assessing differences in risk-adjusted outcomes at minority-serving and non-minority-serving hospitals with a "fixed-effect" approach that estimated the reduction in adverse outcomes if the distribution of minority and white patients across hospitals was the same. We evaluated each method's ability to detect and measure a disparity in outcomes caused by minority patients receiving care at poor-quality hospitals, which we label a "between-hospital" disparity, and to reject it when the disparity in outcomes was caused by factors other than hospital quality.
  
  
  
  The minority-serving and fixed-effect approaches correctly identified between-hospital disparities in quality when they existed and rejected them when racial differences in outcomes were caused by other disparities; however, the fixed-effect approach has many advantages. It does not require an ad hoc definition of a minority-serving hospital, and it estimated the magnitude of the disparity accurately, while the minority-serving approach underestimated the disparity by 35-46 percent.
  
  
  
  Researchers should consider using the fixed-effect approach for measuring disparities in use of high-quality hospital care by vulnerable populations.
authors.affiliation: VA HSR&D Center of Innovation for Patient Centered and Value Driven Health Care, VA Puget Sound Health Care System, Seattle, WA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Hebert
authors.affiliation: Department of Population Health Science and Policy, Mount Sinai School of Medicine, New York, NY.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Howell
authors.affiliation: VA HSR&D Center of Innovation for Patient Centered and Value Driven Health Care, VA Puget Sound Health Care System, Seattle, WA.
authors.forename: Edwin S
authors.initials: ES
authors.lastname: Wong
authors.affiliation: VA HSR&D Center of Innovation for Patient Centered and Value Driven Health Care, VA Puget Sound Health Care System, Seattle, WA.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Hernandez
authors.affiliation: Yale Pulmonary and Critical Care Medicine, New Haven, CT.
authors.forename: Seppo T
authors.initials: ST
authors.lastname: Rinne
authors.affiliation: VA HSR&D Center of Innovation for Patient Centered and Value Driven Health Care, VA Puget Sound Health Care System, Seattle, WA.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Sulc
authors.affiliation: VA HSR&D Center of Innovation for Patient Centered and Value Driven Health Care, VA Puget Sound Health Care System, Seattle, WA.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Neely
authors.affiliation: VA HSR&D Center of Innovation for Patient Centered and Value Driven Health Care, VA Puget Sound Health Care System, Seattle, WA.
authors.forename: Chuan-Fen
authors.initials: CF
authors.lastname: Liu
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D015233:Models, Statistical; D010359:Patient Readmission / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data
keywords: Race; disparities; hospital readmissions