Methods for Measuring Racial Differences in Hospitals Outcomes Attributable to Disparities in Use of High‐Quality Hospital Care. (3rd June 2016) - Hebert, Paul L.
Abstract : Objective: To compare two approaches to measuring racial/ethnic disparities in the use of high‐quality hospitals. Data Sources: Simulated data. Study Design: Through simulations, we compared the "minority‐serving" approach of assessing differences in risk‐adjusted outcomes at minority‐serving and non‐minority‐serving hospitals with a "fixed‐effect" approach that estimated the reduction in adverse outcomes if the distribution of minority and white patients across hospitals was the same. We evaluated each method's ability to detect and measure a disparity in outcomes caused by minority patients receiving care at poor‐quality hospitals, which we label a "between‐hospital" disparity, and to reject it when the disparity in outcomes was caused by factors other than hospital quality. Principal Findings: The minority‐serving and fixed‐effect approaches correctly identified between‐hospital disparities in quality when they existed and rejected them when racial differences in outcomes were caused by other disparities; however, the fixed‐effect approach has many advantages. It does not require an ad hoc definition of a minority‐serving hospital, and it estimated the magnitude of the disparity accurately, while the minority‐serving approach underestimated the disparity by 35–46 percent. Conclusions: Researchers should consider using the fixed‐effect approach for measuring disparities in use of high‐quality hospital care by vulnerable populations.