Even within the same hospital, Black patients endure more harm than white patients

New data suggest Black adult patients experienced more harmful events, such as perioperative pulmonary embolism, than white patients who were the same age, the same gender and were treated in the same hospital.

These disparities persisted when comparing patients with similar types of insurance coverage as well as within hospitals serving a substantial population of Black patients, according to the Urban Institute analysis.

Our previous work suggested increasing the racial diversity of patients that high-quality hospitals serve or concentrating resources to improve quality of care at low-performing hospitals would narrow racial inequities in care,” Anuj Gangopadhyaya, senior research associate at the Urban Institute and the analysis’ lead author, said in a statement. “This study’s findings show that achieving racial equity in patient safety requires transforming the way care is delivered within hospitals as well.”

The Robert Wood Johnson Foundation-funded study reviewed patient data collected by the Agency for Healthcare Research and Quality (AHRQ) across 26 states in 2017. Using the complete hospital discharge records for 2,347 hospitals, Gangopadhyaya compared Black and white patients’ outcomes across 11 AHRQ patient safety indicators—four related to general inpatient safety and seven related to surgical procedures.

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The analysis found a significant increase in overall adverse patient safety events per 1,000 at-risk discharges for Black patients across six of the 11 indicators, five of which were related to surgical procedures.

White patients, meanwhile, were significantly more likely to experience two of the general safety indicators—although these differences were narrow compared to the other indicators with significant differences.

Limiting the comparisons to patients admitted to the same hospitals “slightly” reduced the Black-white gap in adverse events, Gangopadhyaya wrote. Five of the 11 measures remained significantly more common among Black patients, with the rate difference reaching as high as 30% for perioperative pulmonary embolism or deep vein thrombosis.

Controlling for insurance coverage and type again yielded a similarly minor reduction on the overall difference in Black and white patient safety, he wrote. Black patients also experienced greater rates of adverse safety events relative to white patients regardless of whether more than 25% of patients treated at their hospital were Black or whether more than 25% of discharges had private insurance coverage.

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From a corrective policy perspective, Gangopadhyaya wrote that current programs applying penalties to hospitals for higher rates of adverse events could be extended to measure specific Medicare-covered patient groups—for instance, a Medicare Advantage Star Rating system update that includes direct measures of race or ethnicity disparities.

However, directly addressing within-hospital differences in care quality “will also likely require provider-level interventions to confront and address racial biases in the care that is provided,” such as periodic audits of physician practices, appointments of chief equity officers and aid programs to support a more diverse pipeline of young physicians, he wrote in the study.

Ensuring that patients are informed of the avenues through which they can submit complaints related to discriminatory care would also “spotlight potentially problematic actors to regulatory agencies, insurers and peers,” he wrote.

Healthcare, like other industries, has increased its focus on racial and ethnic disparities over the past year.

Several health systems have kicked off new joint efforts to address systemic racism and reduce health disparities. Physician professional organizations are also outlining their efforts to tackle racial justice and advance health equity—and are cleaning shop when their publications and leadership fall short.