Racial/ethnic disparities in hospital care substantially narrowed after initiation of the Center for Medicare & Medicaid Services’ program to measure and publicly report the quality of care delivered at U.S. hospitals, according to a report published online Dec. 11 in the New England Journal of Medicine.
Investigators assessed changes in hospital performance between 2005-2010 by analyzing information in the program’s database regarding 12,447,154 hospitalizations of adults: 2,831,343 for acute MI, 4,718,790 for heart failure, and 4,897,021 for pneumonia. Over time, disparities in all 17 care quality measures between white patients and black patients narrowed so much that none of them exceeded 3.8%, and disparities between white and Hispanic patients narrowed so much that none of them exceeded 1.1%, said Dr. Amal N. Trivedi of Providence Veterans Affairs Medical Center and the department of health services, policy, and practice, Brown University, both in Providence, R.I., and his associates.
These important improvements were attributed both to increases in equitable care between white and minority patients within each hospital and to greater improvements in care at hospitals that disproportionately serve minority patients. “On some simple measures, such as the provision of aspirin and beta-blockers in patients with acute MI and documentation of assessment of left ventricular function in patients with HF, we observed nearly equivalent performances for white, black, and Hispanic patients,” the investigators said.
In addition, on quality measures with the largest disparities in 2005 – such as performing PCI within 90 minutes of MI presentation, and delivering influenza and pneumococcal vaccinations – “we observed the greatest overall improvement in performance and reductions in racial or ethnic differences over time,” they said (N. Engl. J. Med. 2014 Dec. 11 [doi:10.1056/NEJMoa1405003]).
No single intervention would explain these widespread findings. Rather, complex system-level reforms likely were rapidly disseminated among hospitals, particularly those that serve disproportionately minority patients. For example, the dramatic increase in the rates of providing influenza and pneumococcal immunizations was probably driven by hospitals adopting standing orders for nonphysician staff to vaccinate eligible patients, Dr. Trivedi and his associates said.
“Our study provides support for the notion that efforts to improve the overall quality of care may also reduce racial and ethnic disparities,” they noted.