Black patients have worse safety outcomes, receive care in less safe hospitals

Black Americans are more likely to receive care in hospitals with worst patient safety outcomes than white Americans, and also experience more adverse events after a surgery, according to new research.

The Urban Institute study released Monday found Black patients were significantly less likely to be admitted into hospitals classified as "high quality," which was defined as hospitals that had better rates of safety than the median total on each quality measure. For instance, Black patients were 25.5% less likely than white patients to receive care in a hospital effective at preventing postoperative respiratory failure, and 41.7% less likely than white patients to be admitted to a hospital that was effective at preventing perioperative pulmonary embolisms.

"Black and white patients face different standards of patient safety and some of this disparity can be attributed to differences in the quality of hospitals patients access," study author Anuj Gangopadhyaya wrote. "Patients often use the nearest hospital facilities for care, particularly for urgent conditions, and thus may not be able to choose high-quality hospitals even if they are available. Thus, improving access to high-quality hospital care may require bolder policies beyond healthcare–specific policies to enable patients to reside closer to high-quality hospital facilities than they otherwise would."

The Urban Institute used 2017 hospital discharge records from 26 states, and looked at 11 patient safety quality indicators, four of which were classified as general, and seven of which were related to surgery adverse events. It looked at patient records by race and where patients received care.

The research found that Black patients were also less likely to receive care in hospitals that had high quality in preventing pressure ulcers, central venous catheter-related blood stream infections, postoperative sepsis, postoperative acute kidney injury requiring dialysis and postoperative hemorrhages.

And the difference in quality scores also extended to the adverse events that Black patients experienced. For every 1,000 Black inpatient discharge who previously underwent an elective surgical procedure, 4.9 Black patients contracted sepsis after their operation, about double compared to white patients. These patients experienced more occurrences of respiratory failure and hematoma after a surgery.

Gangopadhyaya wrote that hospitals can make concerted efforts to improve patient safety, and high-quality hospitals could also try to expand patient access for Black Americans can contribute to reducing these disparities.

"Disparities in patient safety by race are unacceptable symptoms of unequal healthcare in America," Gangopadhyaya wrote. "These differences are addressable, as this analysis shows that many hospitals have been successful in eliminating adverse events across many measures of patient safety."

The data came from 2017 discharge records from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project's state inpatient databases for 26 states, including Georgia, Maryland, Kansas, Arizona, Alaska and Oregon.