Do hospitals provide lower quality of care to black patients for pneumonia?

Mayr, Florian B., Yende, Sachin, D'Angelo, Gina, Barnato, Amber E., Kellum, John A., Weissfeld, Lisa, Yealy, Donald M., Reade, Michael C., Milbrandt, Eric B. and Angus, Derek C. (2010) Do hospitals provide lower quality of care to black patients for pneumonia?. Critical Care Medicine, 38 3: 759-765. doi:10.1097/CCM.0b013e3181c8fd58

Author Mayr, Florian B.
Yende, Sachin
D'Angelo, Gina
Barnato, Amber E.
Kellum, John A.
Weissfeld, Lisa
Yealy, Donald M.
Reade, Michael C.
Milbrandt, Eric B.
Angus, Derek C.
Title Do hospitals provide lower quality of care to black patients for pneumonia?
Journal name Critical Care Medicine   Check publisher's open access policy
ISSN 0090-3493
Publication date 2010-03-01
Year available 2010
Sub-type Article (original research)
DOI 10.1097/CCM.0b013e3181c8fd58
Open Access Status Not yet assessed
Volume 38
Issue 3
Start page 759
End page 765
Total pages 7
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Formatted abstract
Objectives: Recent studies reported lower quality of care for black vs. white patients with community-acquired pneumonia and suggested that disparities persist at the individual hospital level. We examined racial differences in emergency department and intensive care unit care processes to determine whether differences persist after adjusting for case-mix and variation in care across hospitals.

Design: Prospective, observational cohort study.

Setting: Twenty-eight U.S. hospitals.

Patients: Patients with community-acquired pneumonia: 1738 white and 352 black patients.

Interventions: None.

Measurements: We compared care quality based on antibiotic receipt within 4 hrs and adherence to American Thoracic Society antibiotic guidelines, and intensity based on intensive care unit admission and mechanical ventilation use. Using random effects and generalized estimating equations models, we adjusted for case-mix and clustering of racial groups within hospitals and estimated odds ratios for differences in care within and across hospitals.

Main Results: Black patients were less likely to receive antibiotics within 4 hrs (odds ratio, 0.55; 95% confidence interval, 0.43-0.70; p <.001) and less likely to receive guideline-adherent antibiotics (odds ratio, 0.72; 95% confidence interval, 0.57-0.91; p =.006). These differences were attenuated after adjusting for casemix (odds ratio, 0.59; 95% confidence interval; 0.46-0.76 and 0.84; 95% confidence interval, 0.66-1.09). Within hospitals, black and white patients received similar care quality (odds ratio, 1; 95% confidence interval, 0.97-1.04 and 1; 95% confidence interval, 0.97-1.03). However, hospitals that served a greater proportion of black patients were less likely to provide timely antibiotics (odds ratio, 0.84; 95% confidence interval, 0.78-0.90). Black patients were more likely to receive mechanical ventilation (odds ratio, 1.57; 95% confidence interval, 1.02-2.42; p =.042). Again, within hospitals, black and white subjects were equally likely to receive mechanical ventilation (odds ratio, 1; 95% confidence interval,.94-1.06) and hospitals that served a greater proportion of black patients were more likely to institute mechanical ventilation (odds ratio, 1.13; 95% confidence interval, 1.02-1.25).

Conclusions: Black patients appear to receive lower quality and higher intensity of care in crude analyses. However, these differences were explained by different case-mix and variation in care across hospitals. Within the same hospital, no racial differences in care were observed.
Keyword Community-acquired pneumonia
Quality of care
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID R01 GM61992
T32 HL007820-10
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 32 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 33 times in Scopus Article | Citations
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