Changes in patterns of racial disparities in attending low-mortality hospitals and outcomes among patients with...

This exploratory study evaluates patterns of care relative to frequency of admission to high quality hospitals and mortality risk for patients with stroke among varying ethnic groups.

Information from 273,532 adult patients with stroke was abstracted from the 2000 and 2006 National Inpatient Sample. Race/ethnicity was categorized as White, African American, Hispanic/Latino, or Asian/Pacific Islander. Hospitals were ranked based on the risk-adjusted overall stroke mortality rate and then divided into four groups based on the quartiles of the ranking. Changes in disparities in attending the four groups of hospitals across race/ethnicity from 2000 to 2006 were examined. Disparities in mortality risk among patients in four racial/ethnic groups were also examined.

In 2006 as compared to 2000, African American and Hispanic/Latino patients were increasingly likely to be admitted to high-quality hospitals. Disparities related to outcomes did not vary in a predictable manner during this period. Relatively low likelihood of admission to high-quality hospitals persisted among Asian/Pacific Islanders.

Multiple efforts related to expanded access to care may have contributed to greater likelihood of admission to high-quality hospitals for African American and Hispanic patients, but these efforts do not seem to have affected Asian/Pacific Islander patients. Further research is needed to explore mechanisms for improving outcomes in high-risk populations. Policies should continue to support healthcare quality improvement efforts that have shown positive effects on outcomes of patients of all racial/ethnic groups. Programs that help Asian/ Pacific Islander patients to identify and attend high-quality hospitals should also be encouraged.