Study Sees Racial Disparity in Care

Disparities in race and quality of care contribute to the higher proportion of older black patients who are readmitted to a hospital after a heart attack, heart failure, or pneumonia, according to a study conducted by researchers at the Harvard School of Public Health.

The study, conducted over the course of a year, found that elderly black patients had a 13 percent greater chance than elderly white patients of being readmitted to a hospital within 30 days after discharge.

Karen E. Joynt, the study’s lead author, said that the researchers also discovered that older black patients disproportionately received care from lower quality hospitals.

“This is really the coming-together of two issues that we’ve been interested in for some time—first in disparities and second in readmissions,” said Joynt, a research fellow at the School of Public Health.

In designing the study, researchers selected a sample of Medicare patients from 2006 to 2008—just over three million people—that were discharged from a hospital in the U.S. after suffering from a heart attack, heart failure, or pneumonia. They then divided hospitals into “minority-serving” and “non-minority-serving” health care facilities.

According to Joynt, readmission rates were 23 percent higher in the minority-serving hospitals, and blacks had 35 percent higher odds of readmission at a non-minority-serving hospital.

“That told us that both race and the site where care was provided were important in determining whether you were readmitted,” Joynt said.

Joynt said the study was not able to determine why the readmission rates were higher.

“Our suspicion is that it has a lot do with the kind of support and resources that patients have at home, in the outpatient settings, and in transitions of care,” Joynt said.

“If we really want to address disparities in care and the outcome, we need to find ways to help these vulnerable patients during that time period, and it’s going to take targeting both black patients and patients coming from hospitals with a high proportion of minorities,” she said.

Ashish Jha and E. John Orav, associate professors at the School of Public Health, also contributed to the study.

Jha, who is also a physician at Harvard Medical School, said that the causes of inadequate minority health care include other factors besides the site of care.

Poor communication between doctors and minority patients and the quality of follow ups after discharge can also contribute to the problem of higher-than-average readmission rates for minorities, Jha said.

“Here we are, in the year 2011, in a nation that’s made so much progress on race in so many different areas, and we continue to see clearly substantial racial disparities in various aspects of our health care system and it adds to the urgency of trying to fix this problem,” Jha said.

The study was published in today’s issue of the “Journal of the American Medical Association.”

—Staff writer Melanie A. Guzman can be reached at melanieguzman@college.harvard.edu.