In many U.S. cities, most and least racially inclusive hospitals are neighbors, Lown Institute says

A Lown Institute analysis of the most and least racially inclusive U.S. hospitals found that providers on both ends of the spectrum can be located "just a short cab ride" away from each other in many cities. The group's president also warned that care delivery can greatly differ between these "segregated" organizations. (Getty/FG Trade)

A new Lown Institute ranking of U.S. hospitals’ racial inclusivity suggests that many of the country’s most segregated hospitals are in urban areas and that top and bottom performers are frequently located within the same city.

Further, Lown’s analysis placed more than twice as many “elite hospitals” named to U.S. News’ Honor Roll in the bottom third of the racial inclusivity ranking than it did in the upper third.

“The difference between the most and least inclusive hospitals is stark, especially when they are blocks away from each other,” Vikas Saini, M.D., president of the Lown Institute. “As the nation reckons with racial injustice, we cannot overlook our health system. Hospital leaders have a responsibility to better serve people of color and create a more equitable future.”

Announced today by the Lown Institute, the list ranks more than 3,200 hospitals using Medicare claims and U.S. Census Bureau data from 2018. The group awarded higher scores if the hospital served a greater proportion of non-white Medicare patients compared to the demographics of its surrounding community.

Per the research organization, the top three most racially inclusive U.S. hospitals are Metropolitan Hospital Center in New York, Boston Medical Center in Massachusetts and St. Charles Madras in Oregon.

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On the other end of the spectrum, Lown’s three worst racially inclusivity rankings went out to Englewood Hospital and Medical Center in New Jersey, Gateway Regional Medical Center in Illinois and Mariners Hospital in Florida.

The organization also identified 25 U.S. cities with “segregated hospitals,” defined by Lown as a city in which 40% of the hospitals ranked among the highest and lowest diversity categories.

Here, Los Angeles had the highest total volume of high- or low-scoring hospitals. Among the 64 total hospitals within its hospital referral region, 22 were among Lown’s lowest scorers and 14 were among its highest.

However, Philadelphia (78%), Newark, New Jersey (75%) and New York City’s Manhattan (73%) were the most segregated cities with the largest proportion of their total hospitals falling into one extreme or another.

In a statement, the group noted that the top-performing Metropolitan Hospital Center is “just a short cab ride” away from Lenox Hill Hospital, which was ranked 3,163 in terms of inclusivity. Seventy-seven percent of the former’s Medicare patients were people of color versus the latter’s 33%, according to Lown.

These numbers outline the wide gulf in patient demographics that can exist within relatively small geographic distances, Saini said.

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“If you want to see structural racism, just look at big city hospitals during COVID,” Saini said. “Hospitals with a history of serving communities of color needed refrigerator trucks to hold bodies of deceased patients, while wealthier hospitals nearby had empty beds.”

Racial and ethnic minority groups also had a higher proportion of COVID-19 hospitalizations compared to white patients, according to a recent Centers for Disease Control and Prevention (CDC) study.

The healthcare system is increasingly coming to terms with the impact disparities can have on care and outcomes. As some provider organizations launch new joint efforts to address systemic racism and reduce health disparities, others like the American Medical Association are hoping to improve care for marginalized populations by reevaluating long-standing practices that treated race as a biological construct for determining clinical risk factors.