Dataset Information

Measuring hospital-specific disparities by dual eligibility and race to reduce health inequities.

ABSTRACT:

Objective

To propose and evaluate a metric for quantifying hospital-specific disparities in health outcomes that can be used by patients and hospitals.

Data sources/study setting

Inpatient admissions for Medicare patients with acute myocardial infarction, heart failure, or pneumonia to all non-federal, short-term, acute care hospitals during 2012-2015.

Study design

Building on the current Centers for Medicare and Medicaid Services methodology for calculating risk-standardized readmission rates, we developed models that include a hospital-specific random coefficient for either patient dual eligibility status or African American race. These coefficients quantify the difference in risk-standardized outcomes by dual eligibility and race at a given hospital after accounting for the hospital's patient case mix and proportion of dual eligible or African American patients. We demonstrate this approach and report variation and performance in hospital-specific disparities.

Principal findings

Dual eligibility and African American race were associated with higher readmission rates within hospitals for all three conditions. However, this disparity effect varied substantially across hospitals.

Conclusion

Our models isolate a hospital-specific disparity effect and demonstrate variation in quality of care for different groups of patients across conditions and hospitals. Illuminating within-hospital disparities can incentivize hospitals to reduce inequities in health care quality.

SUBMITTER: Lloren A

PROVIDER: S-EPMC6341208 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Publications

Measuring hospital-specific disparities by dual eligibility and race to reduce health inequities.

Lloren Anouk A Liu Shuling S Herrin Jeph J Lin Zhenqiu Z Zhou Guohai G Wang Yongfei Y Kuang Meng M Zhou Sheng S Farietta Thalia T McCole Kerry K Charania Sana S Dorsey Sheares Karen K Bernheim Susannah S

Health services research 20190201

<h4>Objective</h4>To propose and evaluate a metric for quantifying hospital-specific disparities in health outcomes that can be used by patients and hospitals.<h4>Data sources/study setting</h4>Inpatient admissions for Medicare patients with acute myocardial infarction, heart failure, or pneumonia to all non-federal, short-term, acute care hospitals during 2012-2015.<h4>Study design</h4>Building on the current Centers for Medicare and Medicaid Services methodology for calculating risk-standardiz ...[more]

PMID: 30666634

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Project description:BackgroundCriteria for low-dose CT scan lung cancer screening vary across guidelines. Knowledge of the eligible pool across demographic groups can enable policy and programmatic decision-making, particularly for disproportionately affected populations.Research questionWhat are the eligibility rates for low-dose CT scan screening according to sex and race or ethnicity and how do these rates relate to corresponding lung cancer incidence rates?Study design and methodsThis was a cross-sectional study using data from the 2015 National Health Interview Survey adult and cancer control supplement files. In addition to eligibility rates, the ratio of the eligibility rate to the lung cancer incidence rate in a given population group (eligibility to incidence [E-I] ratio) also was determined. Guidelines assessed were: Centers for Medicare and Medicaid Services, National Comprehensive Cancer Network, and US Preventive Services Task Force current or with expansion of age and smoking or quit thresholds. We also assessed a risk model (PLCOM2012 risk model).ResultsTotal numbers eligible based on current guidelines ranged from 8.3 to 13.3 million, representing 8.3% to 13.4% of the US population 50 to 80 years of age, and up to 17.5 million with expanded criteria. Overall eligibility rates on average were about 10 percentage points higher for men than women. For both men and women, and both overall and among ever smokers, non-Hispanic Whites had the highest eligibility rates across all guidelines, followed generally by non-Hispanic Blacks, and then Asians and Hispanics. Among both men and women, non-Hispanic Whites had the highest E-I ratios across all guidelines; non-Hispanic Black men had higher lung cancer incidence, but 30% to 50% lower E-I ratios, than non-Hispanic White men.InterpretationScreening eligibility rates vary widely across guidelines, with disparities evident in E-I ratios, including among non-Hispanic Black men, despite higher lung cancer burden. Consideration of smoking duration in risk assessment criteria may address current disparities.

Dataset Information

Measuring hospital-specific disparities by dual eligibility and race to reduce health inequities.

Objective

Data sources/study setting

Study design

Principal findings

Conclusion

Publications

Measuring hospital-specific disparities by dual eligibility and race to reduce health inequities.

Similar Datasets

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