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Do hospitals provide lower quality of care to black patients for pneumonia?
Crit Care Med. 2010 Mar; 38(3):759-65.CC

Abstract

OBJECTIVES

Recent studies reported lower quality of care for black vs. white patients with community-acquired pneumonia and suggested that disparities persist at the individual hospital level. We examined racial differences in emergency department and intensive care unit care processes to determine whether differences persist after adjusting for case-mix and variation in care across hospitals.

DESIGN

Prospective, observational cohort study.

SETTING

Twenty-eight U.S. hospitals.

PATIENTS

Patients with community-acquired pneumonia: 1738 white and 352 black patients.

INTERVENTIONS

None.

MEASUREMENTS

We compared care quality based on antibiotic receipt within 4 hrs and adherence to American Thoracic Society antibiotic guidelines, and intensity based on intensive care unit admission and mechanical ventilation use. Using random effects and generalized estimating equations models, we adjusted for case-mix and clustering of racial groups within hospitals and estimated odds ratios for differences in care within and across hospitals.

MAIN RESULTS

Black patients were less likely to receive antibiotics within 4 hrs (odds ratio, 0.55; 95% confidence interval, 0.43-0.70; p < .001) and less likely to receive guideline-adherent antibiotics (odds ratio, 0.72; 95% confidence interval, 0.57-0.91; p = .006). These differences were attenuated after adjusting for casemix (odds ratio, 0.59; 95% confidence interval; 0.46-0.76 and 0.84; 95% confidence interval, 0.66 -1.09). Within hospitals, black and white patients received similar care quality (odds ratio, 1; 95% confidence interval, 0.97-1.04 and 1; 95% confidence interval, 0.97-1.03). However, hospitals that served a greater proportion of black patients were less likely to provide timely antibiotics (odds ratio, 0.84; 95% confidence interval, 0.78-0.90). Black patients were more likely to receive mechanical ventilation (odds ratio, 1.57; 95% confidence interval, 1.02-2.42; p = .042). Again, within hospitals, black and white subjects were equally likely to receive mechanical ventilation (odds ratio, 1; 95% confidence interval, .94-1.06) and hospitals that served a greater proportion of black patients were more likely to institute mechanical ventilation (odds ratio, 1.13; 95% confidence interval, 1.02-1.25).

CONCLUSIONS

Black patients appear to receive lower quality and higher intensity of care in crude analyses. However, these differences were explained by different case-mix and variation in care across hospitals. Within the same hospital, no racial differences in care were observed.

Authors+Show Affiliations

Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, Graduate School of Pubic Health, University of Pittsburgh, Pittsburgh, PA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20009756

Citation

Mayr, Florian B., et al. "Do Hospitals Provide Lower Quality of Care to Black Patients for Pneumonia?" Critical Care Medicine, vol. 38, no. 3, 2010, pp. 759-65.
Mayr FB, Yende S, D'Angelo G, et al. Do hospitals provide lower quality of care to black patients for pneumonia? Crit Care Med. 2010;38(3):759-65.
Mayr, F. B., Yende, S., D'Angelo, G., Barnato, A. E., Kellum, J. A., Weissfeld, L., Yealy, D. M., Reade, M. C., Milbrandt, E. B., & Angus, D. C. (2010). Do hospitals provide lower quality of care to black patients for pneumonia? Critical Care Medicine, 38(3), 759-65. https://doi.org/10.1097/CCM.0b013e3181c8fd58
Mayr FB, et al. Do Hospitals Provide Lower Quality of Care to Black Patients for Pneumonia. Crit Care Med. 2010;38(3):759-65. PubMed PMID: 20009756.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Do hospitals provide lower quality of care to black patients for pneumonia? AU - Mayr,Florian B, AU - Yende,Sachin, AU - D'Angelo,Gina, AU - Barnato,Amber E, AU - Kellum,John A, AU - Weissfeld,Lisa, AU - Yealy,Donald M, AU - Reade,Michael C, AU - Milbrandt,Eric B, AU - Angus,Derek C, PY - 2009/12/17/entrez PY - 2009/12/17/pubmed PY - 2010/3/17/medline SP - 759 EP - 65 JF - Critical care medicine JO - Crit Care Med VL - 38 IS - 3 N2 - OBJECTIVES: Recent studies reported lower quality of care for black vs. white patients with community-acquired pneumonia and suggested that disparities persist at the individual hospital level. We examined racial differences in emergency department and intensive care unit care processes to determine whether differences persist after adjusting for case-mix and variation in care across hospitals. DESIGN: Prospective, observational cohort study. SETTING: Twenty-eight U.S. hospitals. PATIENTS: Patients with community-acquired pneumonia: 1738 white and 352 black patients. INTERVENTIONS: None. MEASUREMENTS: We compared care quality based on antibiotic receipt within 4 hrs and adherence to American Thoracic Society antibiotic guidelines, and intensity based on intensive care unit admission and mechanical ventilation use. Using random effects and generalized estimating equations models, we adjusted for case-mix and clustering of racial groups within hospitals and estimated odds ratios for differences in care within and across hospitals. MAIN RESULTS: Black patients were less likely to receive antibiotics within 4 hrs (odds ratio, 0.55; 95% confidence interval, 0.43-0.70; p < .001) and less likely to receive guideline-adherent antibiotics (odds ratio, 0.72; 95% confidence interval, 0.57-0.91; p = .006). These differences were attenuated after adjusting for casemix (odds ratio, 0.59; 95% confidence interval; 0.46-0.76 and 0.84; 95% confidence interval, 0.66 -1.09). Within hospitals, black and white patients received similar care quality (odds ratio, 1; 95% confidence interval, 0.97-1.04 and 1; 95% confidence interval, 0.97-1.03). However, hospitals that served a greater proportion of black patients were less likely to provide timely antibiotics (odds ratio, 0.84; 95% confidence interval, 0.78-0.90). Black patients were more likely to receive mechanical ventilation (odds ratio, 1.57; 95% confidence interval, 1.02-2.42; p = .042). Again, within hospitals, black and white subjects were equally likely to receive mechanical ventilation (odds ratio, 1; 95% confidence interval, .94-1.06) and hospitals that served a greater proportion of black patients were more likely to institute mechanical ventilation (odds ratio, 1.13; 95% confidence interval, 1.02-1.25). CONCLUSIONS: Black patients appear to receive lower quality and higher intensity of care in crude analyses. However, these differences were explained by different case-mix and variation in care across hospitals. Within the same hospital, no racial differences in care were observed. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/20009756/Do_hospitals_provide_lower_quality_of_care_to_black_patients_for_pneumonia L2 - https://dx.doi.org/10.1097/CCM.0b013e3181c8fd58 DB - PRIME DP - Unbound Medicine ER -