The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #69711

Jay J. Shen, PhD, Division of Health Administration and Human Services, College of Health Professions, Governors State University, 1 University Parkway, University Park, IL 60466 and Elmer L. Washington, MD, Aunt Martha Youth Service Center, Inc., 233 West Jor Orr Road, Chicago Heights, IL 60411, (708) 754-1044, ewashington@mail.auntmarthas.org.

This study focuses on racial disparities among diverse ethnicities regarding process and outcome measures for pneumonia. A total of 380,437 hospitalized adult patients diagnosed with pneumonia were abstracted from the 1998 and 1999 National Inpatient Sample. Ethnicity was categorized as non-Hispanic white (82%), African American (11%), Hispanic (5%), and Asian / Pacific Islander (2%). Process measures included routine versus emergency department (ED) admissions and frequency of pneumonia related procedures (including bronchoscopy, chest CT scan, and thoracentesis). Outcome measures included respiratory failure (mechanical ventilation), length of stay (LOS), total charges, in-hospital mortality, and age at death. Age, gender, comorbidities, health insurance status, and income were controlled. All three minority groups were admitted with more severe conditions than whites (average severity indices were 2.9 for whites and 3.3 the minority groups). Both African American patients and Hispanic patients were more likely to be admitted through the ED (Odds ratio 1.94 and 1.43, respectively) while Asian and white patients had similar likelihood of admission through the ED (95% confidence interval CI 0.9, 1.03). African American and Asian patients had similar mortality rates (CI 0.95, 1.03/0.94,1.12, respectively) while Hispanic patients had lower rates (OR 0.94, p=.02). Both African American and Hispanic patients died at younger ages (73.6 and 77.6, respectively) compared to white and Asian patients (79.0 and 79.1, respectively p<0.001). African Americans were less likely to receive procedures than whites (OR 0.95 p=0.04) while Hispanics received procedures at a similar rate (CI 0.94, 1.08) and Asians a higher rate (OR1.14). Whites, African Americans, Hispanics, and Asians incurred average per patient charges of $14423, $16298, $22052, and $27439, respectively, p<0.001 with corresponding length of stays of 6.2, 7.0, 7.2, and 7.3, respectively, p<0.001. Of the populations studied, African Americans had the worst outcomes related to pneumonia. Inadequate provision of resource intensive healthcare is suggested as a contributing factor by the finding that this group also received the fewest procedures among the groups studied. In both Hispanic and African American populations, significant improvement through improved access to ambulatory care and preventive measures should be evaluated to reduce disparities. Public policy should encourage education of health care providers on disparities related to care and encourage health care organization to assess healthcare disparities as part of the quality improvement process.

Learning Objectives:

• 1. Understand how improving access to care for ambulatory sensitive conditions can provide opportunities to eliminate racial disparities and reduce health care cost
• 2. Understand how changing patterns of service delivery may create opportunities for eliminating racial disparities
• 3. Understand how policy makers, health care oversight agencies, and accrediting bodies can stimulate efforts by health care organizations to eliminate racial disparities

Keywords: Access to Care, Ethnicity

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.