Bradford H. Gray, Ph.D., Mark Schlesinger, Ph.D., Shannon Mitchell Siegfried, Ph.D., and Emily Horowitz, Ph.D.
B. H. Gray, M. Schlesinger, S. M. Siegfried et al., "Racial and Ethnic Disparities in the Use of High-Volume Hospitals," Inquiry, Fall 2009 46(3):322–38.
Minority patients in the New York City area are significantly less likely than whites to be treated at high-volume hospitals for cancer surgeries, cardiovascular procedures, and other services for which high volume and positive outcomes are related.
Racial and ethnic disparities in health care and treatment outcomes have been well documented in the United States, but the causes are poorly understood. Various issues may be involved, but a key question remains: are differences in the source of care a contributing factor? Hospitals that perform a large number of a given surgery or procedure can often provide better patient outcomes for that particular service. The authors of this study examined racial and ethnic differences in the patterns of use of high-volume hospitals for 17 services for which there is a relationship between high volume and positive outcomes.
Even in a large, racially diverse metropolitan area, where high-volume hospitals are relatively accessible geographically to the entire population, researchers found evidence of racial and ethnic disparities. These findings raise important questions about the way that patients, particularly minorities, gain access to care. For example, many may prefer providers with whom they are familiar. The authors recommend policies that increase the number of high-volume hospitals among the providers of a given service. For example, New York's certificate-of-need program limited the number of institutions that perform common procedures like angioplasties, resulting in a majority of hospitals that perform a high volume of these procedures. "When the majority of patients use high-volume hospitals, there are fewer racial and ethnic disparities," the authors conclude.
The researchers used patient discharge records from hospitals in New York City, plus adjacent counties, in the periods 1995–1996 and 2001–2002. The study focused on patients hospitalized for 17 services (five types of cancer surgery, six cardiovascular services, three orthopedic procedures, two prostate procedures, and admission for AIDS) with positive volume–outcome relationships. Demographic information indicated if patients were Hispanic, white, black, Asian or Pacific Islander, or other. The researchers controlled for socioeconomic characteristics, insurance coverage, and other factors. The Agency for Healthcare Research and Quality and The Commonwealth Fund supported the study.
Minority patients in the New York City area are significantly less likely than whites to be treated at high-volume hospitals for services for which high volume is associated with better outcomes, raising important questions about the ways in which racial and ethnic groups gain access to medical care.