HEALTH-CARE FOR BLACK AND POOR HOSPITALIZED MEDICARE PATIENTS

Objective.-To analyze whether elderly patients who are black or from p oor neighborhoods receive worse hospital care than other patients, tak ing account of hospital effects and using validated measures of qualit y of care. Design.-We compare quality of care provided to insured, hos pitalized Medicare patients who are black or live in poor neighborhood s as compared with others, using simple and multivariable comparisons of clinically detailed measures of sickness at admission, quality, and outcomes. Setting.-Two hundred ninety-seven acute care hospitals in 3 0 areas within five states. Patients or Other Participants.-The sample includes a nationally representative sample of 9932 patients 65 years of age or older who lived at home prior to hospitalization for conges tive heart failure, acute myocardial infarction, pneumonia, or stroke. Interventions.-This was an observational study. Main Outcome Measures .-Processes of care, length of stay, instability at discharge, dischar ge destination, and mortality. Results.-Within rural, urban nonteachin g, and urban teaching hospitals, patients who are black or from poor n eighborhoods have worse processes of care and greater instability at d ischarge than other patients (P<.05). However, this worse quality is o ffset by patients who are black or from poor neighborhoods being 1.8 t imes more likely to receive care in urban teaching hospitals that have been shown to provide better quality of care (P<.001). Because these patients receive more of their care in better-quality hospitals, there are no overall differences in quality by race and poverty status. Dea th rates did not vary by race or poverty status. Conclusions.-Quality of hospital care for insured Medicare patients is influenced both by t he patient's race and financial characteristics and by the hospital ty pe in which the patient receives care.