Black patients more likely to experience hospital-acquired injury or illness
Black adults had a higher rate of hospital-acquired injuries or illnesses than white adults who were treated at the same hospitals, an analysis showed.
“No studies have examined within-hospital differences in patient safety indicators between Black and white patients broadly across many states and hospitals and after implementation of the Affordable Care Act’s main provisions in 2014,” Anuj Gangopadhyaya, a senior research associate at the Urban Institute, and colleagues wrote in the report.
The researchers analyzed information from adults within the Agency for Healthcare Research and Quality’s 2017 Healthcare Cost and Utilization Project. The analysis included state inpatient databases for 2,347 hospitals in 26 states.
Four measures of general patient safety were assessed: rates of pressure ulcers, iatrogenic pneumothoraxes, central venous catheter-related bloodstream infections and in-hospital falls with hip fracture. The researchers also assessed seven measures of adverse events potentially stemming from surgical procedures: perioperative hemorrhage or hematoma rate; perioperative pulmonary embolism or deep vein thrombosis rate; postoperative acute kidney injury requiring dialysis rate; postoperative respiratory failure rate; postoperative sepsis rate; postoperative wound dehiscence rate; and abdominopelvic accidental puncture or laceration rate.
Gangopadhyaya and colleagues reported that in six of the 11 measures analyzed, Black patients experienced significantly worse patient safety outcomes compared with white patients in the same age group, of the same sex and in the same hospital. Among Black patients, adverse safety events related to the surgical measures occurred more frequently than the general patient safety measures. Compared with white adults, Black adults had higher rates of pressure ulcers (1.19 vs. 0.09 cases per 1,000 at-risk discharges), catheter-related infections (0.17 vs. 0.06 cases per 1,000 at-risk discharges), perioperative hemorrhage or hematoma (2.75 vs. 0.68 cases per 1,000 at-risk discharges), perioperative pulmonary embolism (5.1 vs. 2.12 cases per 1,000 at-risk discharges), postoperative sepsis (4.82 vs. 1.88 cases per 1,000 at-risk discharges) and postoperative respiratory failure (5.62 vs. 1.6 cases per 1,000 at-risk discharges).
The researchers noted that inconsistencies in safety among Black and white patients within the same hospital were prevalent, regardless of insurance. Black patients also experienced worse safety events than white patients in hospitals that served more Black patients. Five of the six safety measures that were more prevalent among Black patients stayed significant across hospitals where more than 25% of the patient population was Black.
“Our previous work increasing the racial diversity of patients that high-quality hospitals serve or concentrating resources to improve quality of care at low-performing hospitals would narrow racial inequities in care,” Gangopadhyaya said in a press release. “This study’s findings show that achieving racial equity in patient safety requires transforming the way care is delivered within hospitals as well.”
Time and again, research has shown the health system must change its status quo when it comes to treating patients, according to Mona Shah, a senior program officer at the Robert Wood Johnson Foundation, the organization that funded the study.
“Studies show the health care system fails Black patients regardless of their age, gender, insurance status or where they access care,” she said in a press release. “The way care is delivered to diverse patients must fundamentally change and achieving equitable outcomes needs to be a health care priority.”
Gangopadhyaya A, et al. Urban Institute. Do Black and White Patients Experience Similar Rates of Adverse Safety Events at the Same Hospital?https://www.urban.org/research/publication/do-black-and-white-patients-experience-similar-rates-adverse-safety-events-same-hospital. Accessed July 20, 2021.