JAMA
1994 Apr 20;271(15):1169-74
Comment in: JAMA. 1994 Apr 20;271(15):1207-8.
Health care for black and poor hospitalized Medicare patients.
Kahn KL, Pearson ML, Harrison ER, Desmond KA, Rogers WH, Rubenstein LV,
Brook RH, Keeler EB.
Health Program of RAND, Santa Monica, CA.
OBJECTIVE: To analyze whether elderly patients who are
black or from poor neighborhoods receive worse hospital care than other
patients, taking account of hospital effects and using validated measures
of quality of care.
DESIGN: We compare quality of care provided to insured,
hospitalized Medicare patients who are black or live in poor neighborhoods
as compared with others, using simple and multivariable comparisons of
clinically detailed measures of sickness at admission, quality, and outcomes.
SETTING: Two hundred ninety-seven acute care hospitals
in 30 areas within five states.
PATIENTS OR OTHER PARTICIPANTS: The sample includes a
nationally representative sample of 9932 patients 65 years of age or older
who lived at home prior to hospitalization for congestive heart failure,
acute myocardial infarction, pneumonia, or stroke.
INTERVENTIONS: This was an observational study.
MAIN OUTCOME MEASURES: Processes of care, length of stay,
instability at discharge, discharge destination, and mortality.
RESULTS: Within rural, urban nonteaching, and urban teaching
hospitals, patients who are black or from poor neighborhoods have worse
processes of care and greater instability at discharge than other patients
(P < .05). However, this worse quality is offset by patients who are
black or from poor neighborhoods being 1.8 times more likely to receive
care in urban teaching hospitals that have been shown to provide better
quality of care (P < .001). Because these patients receive more of
their care in better-quality hospitals, there are no overall differences
in quality by race and poverty status. Death rates did not vary by race
or poverty status.
CONCLUSIONS: Quality of hospital care for insured Medicare
patients in influenced both by the patient's race and financial characteristics
and by the hospital type in which the patient receives care.
PMID: 8151874 [PubMed - indexed for MEDLINE]
JAMA 1994 Apr 20;271(15):1207-8
Comment on:
JAMA. 1994 Apr 20;271(15):1169-74.
JAMA. 1994 Apr 20;271(15):1175-80.
Race, class, and the quality of medical care.
Ayanian JZ.
Publication Types: Comment, Editorial
PMID: 8151880 [PubMed - indexed for MEDLINE]
