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- Title
Methods for Measuring Racial Differences in Hospitals Outcomes Attributable to Disparities in Use of High-Quality Hospital Care.
- Authors
Hebert, Paul L.; Howell, Elizabeth A.; Wong, Edwin S.; Hernandez, Susan E.; Rinne, Seppo T.; Sulc, Christine A.; Neely, Emily L.; Liu, Chuan‐Fen
- Abstract
<bold>Objective: </bold>To compare two approaches to measuring racial/ethnic disparities in the use of high-quality hospitals.<bold>Data Sources: </bold>Simulated data.<bold>Study Design: </bold>Through simulations, we compared the "minority-serving" approach of assessing differences in risk-adjusted outcomes at minority-serving and non-minority-serving hospitals with a "fixed-effect" approach that estimated the reduction in adverse outcomes if the distribution of minority and white patients across hospitals was the same. We evaluated each method's ability to detect and measure a disparity in outcomes caused by minority patients receiving care at poor-quality hospitals, which we label a "between-hospital" disparity, and to reject it when the disparity in outcomes was caused by factors other than hospital quality.<bold>Principal Findings: </bold>The minority-serving and fixed-effect approaches correctly identified between-hospital disparities in quality when they existed and rejected them when racial differences in outcomes were caused by other disparities; however, the fixed-effect approach has many advantages. It does not require an ad hoc definition of a minority-serving hospital, and it estimated the magnitude of the disparity accurately, while the minority-serving approach underestimated the disparity by 35-46 percent.<bold>Conclusions: </bold>Researchers should consider using the fixed-effect approach for measuring disparities in use of high-quality hospital care by vulnerable populations.
- Subjects
HOSPITAL care quality; HEALTH &; race; HEALTH equity; COMPUTER simulation; HEALTH of minorities; HOSPITAL statistics; BLACK people; HEALTH services accessibility; HEALTH status indicators; HOSPITALS; MEDICAL quality control; POPULATION; RESEARCH funding; WHITE people; PATIENT readmissions; STATISTICAL models
- Publication
Health Services Research, 2017, Vol 52, Issue 2, p826
- ISSN
0017-9124
- Publication type
journal article
- DOI
10.1111/1475-6773.12514