Journal article
Racial Differences in Admissions to High-Quality Hospitals for Coronary Heart Disease
Archives of internal medicine (1960), Vol.170(14), pp.1209-1215
2010
DOI: 10.1001/archinternmed.2010.227
PMID: 20660838
Abstract
Background: Research increasingly shows that blacks with coronary heart disease (CHD) are treated at lower-quality hospitals. Little is known about racial differences in admission to high-quality hospitals.
Methods: We identified all black and white Medicare patients with acute myocardial infarction and coronary artery bypass grafting (CABG) admitted during 2002 through 2005 to hospitals located in markets with top-ranked cardiac hospitals, as ascertained from the US News and World Report "America's Best Hospitals" annual rankings. The relationship between race and admission to top-ranked hospitals was estimated using multinomial conditional logit models to account for distance from patient residence to all available hospitals.
Results: In unadjusted analyses, blacks with AMI or undergoing CABG, compared with whites, were more likely to be admitted to top-ranked hospitals (18.3% vs 10.5% and 34.4% vs 22.7% [P < .001]) but also more likely to bypass top-ranked hospitals (25.8% vs 14.7% and 37.5% vs 26.3% [P < .001]). In models accounting for distance, blacks with acute myocardial infarction were more likely (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.08-1.16 [P < .001]), whereas blacks undergoing CABG were equally likely (OR, 1.05; 95% CI, 0.97-1.13; P = .27) to be admitted to top-ranked hospitals compared with whites. However, within socially disadvantaged zip codes, blacks undergoing CABG were less likely to receive care at top-ranked hospitals (OR, 0.75; 95% CI, 0.64-0.86 [P < .001]) compared with whites and more likely to bypass top-ranked hospitals located closer to their residence (OR, 1.16; 95% CI, 1.02-1.30 [P = .03]).
Conclusion: Black Medicare patients with acute myocardial infarction or undergoing CABG were equally or more likely to be admitted to top-ranked hospitals, except for socially disadvantaged black patients undergoing CABG.
Details
- Title: Subtitle
- Racial Differences in Admissions to High-Quality Hospitals for Coronary Heart Disease
- Creators
- Ioana POPESCU - The Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City VA Medical Center, and Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, United StatesBrahmajee K NALLAMOTHU - The Health Services Research & Development Center of Excellence, Ann Arbor Department of Veterans Affairs Medical Center, Ann Arbor, Michigan, United StatesMary S VAUGHAN-SARRAZIN - The Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City VA Medical Center, and Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, United StatesPeter CRAM - The Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City VA Medical Center, and Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, United States
- Resource Type
- Journal article
- Publication Details
- Archives of internal medicine (1960), Vol.170(14), pp.1209-1215
- DOI
- 10.1001/archinternmed.2010.227
- PMID
- 20660838
- NLM abbreviation
- Arch Intern Med
- ISSN
- 0003-9926
- eISSN
- 1538-3679
- Publisher
- American Medical Association; Chicago, IL
- Language
- English
- Date published
- 2010
- Academic Unit
- Health Management and Policy; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984063122402771
Metrics
16 Record Views