Racial disparities in hospital use and quality of care for coronary heart disease

描述(申请人提供)：研究表明，心脏病治疗中的种族差异部分是由于白人和黑人患者所使用的医院质量的差异。一种可能的解释是，黑人居住在医院更差的社区。然而，最近的研究发现，黑人也比白人更有可能离开声誉良好的高质量医院，特别是非紧急的专门治疗，即使他们住在这些设施附近。因此，区位以外的因素可能会在 黑人和白人如何使用高质量和低质量的医院。我们假设，即使在考虑了地点之后，黑人患者也更有可能使用质量较差的医院和医院 这些公司位于黑人占多数的社区，或者有相当大的黑人客户。这可能是由于医生转诊的差异或患者对以白人为主的机构的不信任造成的，并可能导致黑人绕过高质量医院的比率更高。我们进一步假设，在黑人和白人使用高质量和低质量医院的方式上，种族差异在居民区高度隔离的大都市地区和社会劣势严重的社区更加明显。拟议的研究将专注于三种不同程度敏感度的心脏疾病-急性心肌梗死、血管成形术和冠状动脉搭桥手术-并将使用几个国家数据来源，包括医疗保险文件来识别患者和他们使用的医院；美国医院协会对医院特征的调查；以及美国人口普查，以获得邮政编码和大都市区人口统计和隔离措施。分析将使用专门为研究医院选择而开发的最先进的方法。这项研究将通过回答与导致心脏病医院治疗中的种族差异的因素有关的重要问题，加强我们对卫生保健差异的因果路径的理解。地理位置对黑人和白人老年人获得高质量医院的机会有影响吗？是一家医院的 社区的种族构成在黑人老年人中尤为突出？这些影响是否被大都会地区住宅隔离的程度所改变？在地域上的差异，以及黑人和白人老年人选择医院的方式的差异，对医疗质量的隔离有什么贡献？拟议的研究将解决这些和更多的问题。此外，通过量化地理位置和医院选择行为的相对作用，这项研究将为旨在减少各自大都市地区差异的地方政策制定者提供有价值的信息。

DESCRIPTION (provided by applicant): Research suggests that racial disparities in heart disease treatment are due in part to differences in the quality of hospitals used by white and black patients. One possible explanation is that blacks live in neighborhoods with worse hospitals. However, recent studies have found that blacks are also more likely than whites to travel beyond reputable, high quality hospitals, especially for non-urgent specialized treatments, even when they live close to these facilities. Thus, factors other than location may play a role in how blacks and whites use high and low quality hospitals. We assume that, even after accounting for location, black patients are more likely to use lower quality hospital and hospitals that are located in majority black neighborhoods or have a sizable black clientele. This may be the consequence of differences in physician referrals or patient distrust of predominantly white institutions, and is likely to result in higher rates of bypass of high-quality hospitals among blacks. We further assume that the racial differences in how blacks and whites use high and low quality hospitals are more pronounced in metro areas with high residential segregation and in neighborhoods with high social disadvantage. The proposed research will focus on three cardiac conditions with various degrees of acuity - acute myocardial infarction, angioplasty, and coronary artery bypass surgery - and will use several national data sources, including Medicare files to identify patients and hospitals they use; American Hospital Association surveys for hospital characteristics; and the US Census to obtain zip code and metro area demographics and segregation measures. Analyses will employ state-of-the-art methods developed specifically for the study of hospital choice. The study will enhance our understanding of causal pathways in health care disparities by answering important questions related to factors contributing to racial differences in hospital care for the treatment of heart disease. Does geography play a role in black and white seniors' access to high quality hospitals? Is a hospital's neighborhood racial composition particularly salient to black seniors? Are these effects modified by the degree of metro area residential segregation? What is the contribution of differences in geographic access, and of differences in how black and white seniors choose hospitals, to the segregation of health care quality? The proposed study will address these and many more questions. Further, by quantifying the relative roles of geography and hospital choice behavior, the study will provide valuable information to local policy makers aiming to reduce disparities in their respective metro areas.