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

描述（由申请人提供）：研究表明，心脏病治疗的种族差异部分是由于白色和黑人患者使用的医院质量的差异。一个可能的解释是，黑人居住的社区医院更差。然而，最近的研究发现，黑人也比白人更有可能前往信誉良好的高质量医院以外的地方，特别是接受非紧急专门治疗，即使他们住在这些设施附近。因此，除位置以外的其他因素也可能在 黑人和白人如何使用高质量和低质量的医院。我们假设，即使考虑到地理位置，黑人患者更有可能使用质量较低的医院和医院 位于黑人占多数的社区，或者有相当大的黑人客户。这可能是医生转诊的差异或患者对以白色为主的机构的不信任的结果，并可能导致黑人绕过高质量医院的比例更高。我们进一步假设，在黑人和白人如何使用高质量和低质量的医院的种族差异更明显的大都市地区与高居住隔离和社区的社会地位低下。拟议的研究将集中在三种不同程度的心脏病-急性心肌梗死，血管成形术和冠状动脉搭桥手术-并将使用几个国家的数据来源，包括医疗保险文件，以确定他们使用的患者和医院;美国医院协会调查医院特征;和美国人口普查，以获得邮政编码和大都会地区的人口统计和隔离措施。分析将采用专门为医院选择研究开发的最先进的方法。这项研究将通过回答与心脏病治疗的医院护理中种族差异相关的因素的重要问题，增强我们对医疗保健差异的因果途径的理解。地理位置是否在黑人和白色老年人进入高质量医院方面发挥作用？是医院的 社区的种族构成对黑人老年人特别突出？这些影响是否会因都市区居住隔离的程度而改变？地理位置的差异，以及黑人和白色老年人选择医院的差异，对医疗保健质量的隔离有什么贡献？拟议的研究将解决这些问题和更多的问题。此外，通过量化地理和医院选择行为的相对作用，该研究将为当地政策制定者提供有价值的信息，旨在减少各自都市地区的差距。

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.