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 Overall, black people were about 19 percent more likely to die or
experience serious complications than white patients, the analysis
of nationwide hospital data found.
But when black people received treatment at hospitals with more
diverse patient populations, they were 20 percent less likely to die
or experience major complications than counterparts seen at
hospitals with less racial diversity.
While the study can't prove diversity improves outcomes for black
patients, the findings suggest that doctors may do a better job of
caring for minorities when they routinely see patients from a broad
variety of racial and ethnic backgrounds, said lead study author Dr.
Philip Okafor, a researcher at the Mayo Clinic in Rochester,
Minnesota.
"Our underlying hypothesis is that hospitals and providers that
treat more minority patients have higher levels of cultural
competency," Okafor said by email.
Previously, researchers thought black patients might have worse
outcomes because they didn't get to the hospital soon enough or
because they had multiple complex medical issues that complicated
their care, Okafor added.
"However, our results demonstrate that even when African-Americans
came to the hospital for care, they had poorer outcomes in hospitals
that treated a lower proportion of African-Americans," Okafor said.
To assess how the diversity of patient populations influences
outcomes for black people, Okafor and colleagues analyzed data on
more than 848,000 admissions at almost 3,400 hospitals nationwide.
They focused on five common gastrointestinal problems – cirrhosis
and alcoholic hepatitis, gastrointestinal hemorrhages,
gastrointestinal obstructions, irritable bowel disease and
gallbladder surgery.
At the hospital level, the majority of patients were white, and the
proportion of minorities typically ranged from 26 percent to 30
percent.
Hospital charges overall were 36 percent higher for black patients
than for white people, researchers report in The American Journal of
Gastroenterology.
However, when black patients were seen at hospitals with more
diverse populations, their charges were 51 percent lower than if
they were seen at hospitals with less diversity.
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Black patients also had slightly shorter hospital stays, an
indicator of the quality of care, when they were treated at
hospitals with more diverse patient populations. The difference was
less than a day, though.
Limitations of the study include its reliance on claims data used
for billing purposes, which doesn't capture nuances like quality of
care, the authors note. The researchers also lacked data on the
diversity among clinicians, which might influence outcomes for black
patients.
Often, hospital outcomes are related to volume, with patients
getting better surgery results when surgeons do more of the same
procedure.
"There could be a volume effect with racially diverse hospitals
simply treating more minority patients," said Dr. Daniel Chu, a
researcher at the University of Alabama at Birmingham who wasn't
involved in the study.
"In many of these circumstances, by treating the same situation
repeatedly, a system is present or developed that provides
standardized and consistent care not only on the medical front, but
also in other dimensions such as social support, financial support,
easy access, etc.," Chu added by email. "These other dimensions may
be particularly important or needed for minority patients."
SOURCE: http://bit.ly/1pKOSb8 American Journal of Gastroenterology,
online March 22, 2016.
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