News: Racial disparities in hospital patient safety, study shows

A new report written by researchers at the Urban Institute found that differences in the quality of hospitals that Black and white patients have access to are a driver of patient safety disparities between the two groups, HealthLeaders reported.

While racial care disparities have been a concern in healthcare for decades, these disparities have drawn heightened attention during the COVID-19 pandemic. Minority racial groups, including the Black, American Indian, and Hispanic populations, have experienced disproportionately high rates of negative outcomes. According to the COVID Tracking Project, Native Hawaiians or Pacific Islanders were more likely to contract the virus than other groups. In terms of mortality, Black COVID-19 patients are dying at 2.1 times the rate of white people, American Indians are dying more than 1.5 times the rate of white patients, and Hispanics are also dying at nearly 1.5 times the rate of white people.

The Urban Institute report examines 2017 hospital discharge data from the Agency for Healthcare Research and Quality's (AHRQ) Cost and Utilization Project. The researchers also used AHRQ software to focus on 11 patient safety indicators (PSI).

Four of the PSIs were categorized as "general," including pressure ulcer rate and central venous catheter-related blood stream infection rate. The other seven PSIs were categorized as "surgery-related," including perioperative hemorrhage or hematoma rate and postoperative sepsis rate.

The researchers also categorized hospitals as "high quality" or "low quality" based on whether a hospital was above or below the median value of each PSI. Four primary findings are featured in the report.

1. Compared to white patients, Black patients experienced worse care quality for six of the 11 PSIs. The care disparity was particularly notable for surgery-related PSIs, with Black patients experiencing worse care quality compared to white patients for five of the seven measures.
2. When the researchers focused on Medicare beneficiaries, there were similar Black-white disparities in PSIs.
3. Black patients were less likely to be admitted to high quality hospitals for nine of the 11 PSIs. The care disparity was particularly notable for surgery related PSIs, with Black patients less likely to be admitted to high quality hospitals for six of the seven PSIs. White patients were 9% more likely to be admitted to high quality hospitals on four PSIs and more than 7% more likely to be admitted to high quality hospitals on six indicators.
4. Compared to white patients, Black patients were less likely to be admitted to high quality hospitals for two or more of the four general PSIs. Compared to white patients, Black patients were 7.9% more likely to be admitted to low quality hospitals for all seven of the surgery related PSIs. Compared to white patients, Black patients were 4.9% less likely to be admitted to high quality hospitals for all of the surgery related PSIs.

"This study finds that Black and white patients face different standards of patient safety and that some of this disparity can be attributed to differences in the quality of hospitals patients access. Black-white disparities in patient safety are larger for quality measures surrounding surgical procedures, and Black patients are significantly less likely than white patients to access the hospitals best able to minimize these adverse surgery-related patient safety risks," the report says.

Editor’s note: This article was originally published by HealthLeaders. ACDIS coverage of the state of minorities and COVID-19 can be found here. ACDIS coverage of addressing health disparities with social determinants of health can be found here.