1. Measuring hospital-specific disparities by dual eligibility and race to reduce health inequities
- Author
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Jeph Herrin, Shuling Liu, Meng Kuang, Sheng Zhou, Zhenqiu Lin, Karen Dorsey Sheares, Sana Charania, Yongfei Wang, Anouk Lloren, Thalia P. Farietta, Guohai Zhou, Kerry McCole, and Susannah M. Bernheim
- Subjects
Male ,medicine.medical_specialty ,Dual MEDICAID MEDICARE Eligibility ,Myocardial Infarction ,quality measurement ,Medicare ,Patient Readmission ,Special Issue: Health Equity ,03 medical and health sciences ,Race (biology) ,Insurance Claim Review ,0302 clinical medicine ,Case mix index ,dual eligibility ,Acute care ,medicine ,Humans ,030212 general & internal medicine ,Healthcare Disparities ,race ,Aged ,Quality of Health Care ,disparities ,African american ,Heart Failure ,Inpatients ,Health Equity ,business.industry ,030503 health policy & services ,Health Policy ,Multilevel model ,Racial Groups ,Pneumonia ,Hospitals ,United States ,Family medicine ,Female ,Metric (unit) ,0305 other medical science ,business ,Medicaid ,Health care quality - 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.
- Published
- 2019