J
Gen Intern Med 1996 Jul;11(7):387-96
Race, resource use, and survival in seriously ill hospitalized adults.
The SUPPORT Investigators.
Phillips RS, Hamel MB, Teno JM, Bellamy P, Broste SK, Califf RM, Vidaillet
H, Davis RB, Muhlbaier LH, Connors AF Jr.
Division of General Medicine and Primary Care, Beth Israel Hospital,
Boston, Mass 02215, USA.
OBJECTIVE: To examine the association between patient
race and hospital resource use.
DESIGN: Prospective cohort study.
SETTING: Five geographically diverse teaching hospitals.
PATIENTS: Patients were 9,105 hospitalized adults with
one of nine illnesses associated with an average 6-month mortality of
50%.
MEASUREMENTS AND MAIN RESULTS: Measures of resource use
included: a modified version of the Therapeutic Intervention Scoring System
(TISS); performance of any of five procedures (operation, dialysis, pulmonary
artery catheterization, endoscopy, and bronchoscopy); and hospital charges,
adjusted by the Medicare cost-to-charge ratio per cost center at each
participating hospital. The median patient age was 65; 79% were white,
16% African-American, 3% Hispanic, and 2% other races; 47% died within
6 months. After adjusting for other sociodemographic factors, severity
of illness, functional status, and study site, African-Americans were
less likely to receive any of five procedures on study day 1 and 3 (adjusted
odds ratio [OR] 0.70; 95% confidence interval [CI] 0.60, 0.81). In addition,
African-Americans had lower TISS scores on study day 1 and 3 (OR -1.8;
95% CI-1.3, -2.4) and lower estimated costs of hospitalization (OR (-)$2,805;
95% CI (-)$1,672, (-)$3,883). Results were similar after adjustment for
patients' preferences and physicians' prognostic estimates. Differences
in resource use were less marked after adjusting for the specialty of
the attending physician but remained significant. In a subset analysis,
cardiologists were less likely to care for African-Americans with congestive
heart failure (p < .001), and cardiologists used more resources (p
< .001). After adjustment for other sociodemographic factors, severity
of illness, functional status, and study site, survival was slightly better
for African-American patients (hazard ratio 0.91; 95% CI 0.84, 0.98) than
for white or other race patients.
CONCLUSIONS: Seriously ill African-Americans received
less resource-intensive care than other patients after adjustment for
other sociodemographic factors and for severity of illness. Some of these
differences may be due to differential use of subspecialists. The observed
differences in resource use were not associated with a survival advantage
for white or other race patients.
PMID: 8842929 [PubMed - indexed for MEDLINE]
