EMBARGOED FOR RELEASE Monday, December 6, 1999, 12:01 P.M.
Contact: John Lacey, Harvard Medical School, 617-432-0441 [email protected]
Black Medicare Patients Receive Substandard Care For Even Basic Medical Procedures
Deficits In Quality Medical Care For Blacks With Congestive Heart Failure Greater In Non-Teaching Hospitals
BOSTON--December 6, 1999--A new study by Harvard researchers shows black Medicare patients in three large states hospitalized with heart failure or pneumonia--the two most common causes for hospitalization among Medicare patients--received poorer quality of care for basic hospital services, such as history taking, diagnostic tests, or standard drug therapies, than other Medicare patients treated for the same illnesses. While previous research has shown racial differences in access to effective major medical procedures such as kidney transplantation, coronary artery by-pass surgery, or total knee and hip replacement, few studies have examined whether basic levels of care are similarly impacted. Today's study, published in the December issue of the journal Medical Care, demonstrates that widespread racial differences in quality of care persist for even simple hospital services.
For example, the study showed that only 32 percent of the black pneumonia patients were given antibiotics within six hours of admission, compared with 53 percent of the other Medicare patients with the disease. Similarly, black patients with pneumonia were less likely to have had their blood cultures collected on the first or second day of hospitalization. Prompt administration of antibiotics and collection of blood cultures have been associated with lower mortality rates in prior research. Based on earlier research, the quality disparities recorded may have resulted in one additional death among every 200 patients treated, or a one-half percent increase in the 30-day death rate of the black patients whose cases were reviewed.
"This study, because it examines noninvasive and relatively low-risk medical services, casts even more doubt on the theory that patient preference may somehow explain the racial disparity in medical care that exists today," says John Ayanian, MD, MPP, assistant professor of medicine and of health care policy at Harvard Medical School and Brigham and Women's Hospital. "Our findings also indicate that physicians, nurses, delivery system managers and policy-makers must continue striving to eliminate racial disparities in the quality of medical care, particularly for common, serious conditions such as heart failure and pneumonia."
The study also showed that the greater use of teaching hospitals by black patients had favorable effects on the overall quality of care they received because urban teaching hospitals provided better care in general. However, after controlling for hospital teaching status by factoring in care received in other settings, the adjusted differences showed significantly poorer overall treatment for congestive heart failure was given to both blacks and women.
Additionally, the study analyzed the quality of care of male and female Medicare patients, regardless of race. Overall, the quality was roughly equivalent. However, the study showed that men received better care than women from doctors, while the women tended to receive better nursing care than men.
The findings are based on reviews by separate panels of physicians and nurses of the medical records of nearly 2,200 Medicare patients 65 years of age and older treated for heart failure or pneumonia in 501 Illinois, New York and Pennsylvania hospitals in 1991 and 1992.
The physicians provided implicit review, meaning they studied each patient's medical record for aspects of care such as prognosis, tests and treatments given, treatment goals and discharge plan, following which they rated the patient's care according to a scale ranging from excellent to very poor. The registered nurse panel reviewed patients' records for adherence to explicit process criteria, such as how thoroughly doctors examined patients' heats and lungs or how closely nurses monitored their blood pressure. All the reviewers were blinded to the researchers' hypothesis that the quality of care would differ by the patients' race and sex.
Dr. Ayanian and the study's co-authors, Joel Weissman, PhD, assistant professor of medicine at Massachusetts General Hospital, Scott Chasan-Taber, PhD, of Boston Biostatistics, and Arnold Epstein, MD, professor of medicine and health policy and management at the Harvard School of Public Health and Brigham and Women's Hospital, were funded by a grant from the Agency for Healthcare Research and Quality.
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