title: Racial and Insurance Status Disparities in Patient Safety Indicators among Hospitalized Patients.
abstract: OBJECTIVE
  To examine the association between patient race/ethnicity, insurance status, and their interaction with patient safety indicators among hospitalized patients.
  
  
  METHODS
  Cross-sectional study was conducted. Data were extracted from the 2009 National Inpatient Sample. A total of 3,052,268 patient safety indicator-related discharges were identified. Dependent variables were 11 patient safety indicators (PSI) whereas independent variables included race/ethnicity and insurance status.
  
  
  RESULTS
  As compared with White patients, African American patients were more likely to experience pressure ulcer, post-operative hemorrhage or hematoma, and post-operative pulmonary embolism (PE) or deep vein thrombosis (DVE); Asian/Pacific Islander patients were more likely to experience pressure ulcer, post-operative PE or DVT, and two obstetric care PSIs; whereas Hispanic/Latino patients were more likely to experience post-operative physiometabolic derangement and accidental puncture/laceration. As compared with patients with private insurance, Medicaid patients were more likely to experience pressure ulcer, post-operative physiological metabolic derangement, post-operative PE or DVT, post-operative respiratory failure, post-operative wound dehiscence, and death among surgeries. However, both obstetric care PSIs showed that African Americans, Hispanics, and uninsured patients were less likely to incur them in comparison with their respective counterparts. Furthermore, strong interactive effects between African American and Medicaid on PSIs were detected.
  
  
  CONCLUSIONS
  Although mixed findings in disparities in PSIs were observed in our study, Asian/Pacific Islander patients and Medicaid patients seem to be the most vulnerable. Further, interactive effects between African American and Medicaid indicate that poverty may be a key factor related to disparities in health care. Future research is merited to identify underlying factors that are related to PSIs among Asian/Pacific Islander patients. Strategies are needed to improve PSIs among Medicaid patients, especially during the current Medicaid program expansion due to the implementation of the Affordable Care Act.
authors.affiliation: Department of Health Care Administration and Policy, University of Nevada Las Vegas.
authors.forename: Jay J
authors.initials: JJ
authors.lastname: Shen
authors.affiliation: Department of Health Care Administration and Policy, University of Nevada Las Vegas.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Cochran
authors.affiliation: Department of Health Policy and Management, Indiana University - Purdue University Indianapolis.
authors.forename: Olena
authors.initials: O
authors.lastname: Mazurenko
authors.affiliation: Department of Health Care Administration and Policy, University of Nevada Las Vegas.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Moseley
authors.affiliation: School of Community Health Sciences, University of Nevada Las Vegas.
authors.forename: Guogen
authors.initials: G
authors.lastname: Shan
authors.affiliation: Valley Health System, Las Vegas.
authors.forename: Robin
authors.initials: R
authors.lastname: Mukalian
authors.affiliation: Department of Health Care Administration and Policy, University of Nevada Las Vegas.
authors.forename: Scott
authors.initials: S
authors.lastname: Neishi
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D005006:Ethnicity; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D019458:Insurance Coverage; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D061214:Patient Safety; D011203:Poverty; D011247:Pregnancy; D014481:United States; D044465:White People
keywords: Ethnicity; Medicaid; Patient Safety Indicator; Race; Socioeconomic Status; Uninsured