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Black patients hospitalized with COVID-19 were 11% more likely to die in the hospital or be sent to hospice, and the differences in the hospitals themselves may be the reason, a study in 

The study, published Thursday, examined 44,217 Medicare beneficiaries who were hospitalized between Jan. 1, 2020, and Sept. 21, 2020,and looked at inpatient deaths or discharges to hospice within 30 days of admission. The study focused on the association of mortality with patient-level factors and the admitting hospital.

It has been known that COVID-19 was hitting harder among minority populations, but in smaller studies limited to a single hospital or health system, differences in mortality were found not to be statistically significant when researchers adjusted for clinical or individual patient differences. In this latest study, by researchers from the University of Pennsylvania, the large, geographically diverse data set allowed comparisons across hospitals.

The results suggest that racial residential segregation played a substantial role in the different rates of hospital admission among Black and White patients, that hospitals located in disadvantaged communities may lack adequate financial resources and may provide suboptimal care due to differences in payer mix or community supports.

Differences in exposure or responses to referral patterns may also account for differences in mortality rates among Black and White patients.

 The study population included 33,459 (76%) White participants and 10,758 (24%) Black participants, and observed a total-mortality equivalent rate of 12.86% for White patients and 13.48% for Black patients; 2,634 (8%) White patients and 1,100 (10%) Black patients died as inpatients, and 1,670 (5%) White patients and 350 (3%) Black patients were discharged to hospice.

In an unadjusted comparison with White patients, Black patients had similar likelihoods of dying or being discharged to hospice (OR, 1.06; 95% CI, 0.99-1.12). After adjustment for clinical and sociodemographic patient characteristics, Black patients had greater likelihoods of dying or being discharged to hospice (OR, 1.11; 95% CI, 1.03-1.19).

To further examine these results, researchers used simulation modeling to approximate the change in mortality rates among Black patients if they had instead been admitted to the hospitals where White patients were admitted. In the modeling, researchers observed that Black patients’ rate of mortality or discharge to hospice would have declined from 13.48% to the simulated rate of 12.23% (95% CI for difference, 1.20%-1.30%).

“This cohort study found that Black patients hospitalized with COVID-19 had higher rates of hospital mortality or discharge to hospice than White patients after adjustment for the personal characteristics of those patients,” the authors wrote. “However, those differences were explained by differences in the hospitals to which Black and White patients were admitted.”

Other differences can be explained by adjustment for social, demographic, and clinical factors linked to race. The authors discussed hospital-level solutions, including a greater focus on quality improvement resources to low-quality hospitals. State regulators should incorporate resources and quality improvement initiatives to all hospitals within a state, the authors said.

Articles

A study in JAMA Network Open shows that differences in hospital admission and racial residential segregation could account for increased risks of inpatient mortality and hospice discharge seen among Black patients with COVID-19.

Hospital Differences Explain Higher Mortality Among Black Patients With COVID-19, Study Finds 

Press Ganey was recently granted authorization by CMS to deploy the Primary Care First Patient Experience of Care Survey (PCF PECS).

The program comes as part of CMS’s five-year plan to improve quality and patient experiences while keeping costs low for patients receiving primary care. Press Ganey will begin administering surveys during the inaugural PECS administration period starting Sept. 28 and ending Dec. 21, 2021. The surveying firm will continue to administer surveys throughout the rest of the five-year program.

The CMS intends to measure the impact of the Primary Care First Model, a payment model that supports the delivery of value-based care, by using a targeted set of patient experience assessments. These assessments include CG-CAHPS 3.0 and PFC-centric questions focused on five domains:

The delivery of timely care, appointments, and information.

The quality of communication carried out by providers to patients.

The degree of attention to care by other providers.

The support received by patients taking care of their own health.

Press Ganey’s real-time digital surveys, those of which have already been in circulation, will be supplemented by the new in-person survey methods. Gathering patient experience insights from the use of both digital and in-person data collection methods will optimize PCF program performance.

The approval of the PCF PECS program paired with a recent SPH Analytics acquisition makes Press Ganey the only firm certified to conduct all CMS and NCQA-mandated experience surveys. Survey feedback will gather data necessary to improve the experience of patients with complex and chronic conditions.

“We are proud to receive CMS approval to provide a solution to help drive and sustain improvement in the primary care setting,” said Daniel Litwer, Chief Client Officer at Press Ganey, 

. “Feedback from patients will produce critical insight into how this model impacts and reshapes the experience for those with complex and chronic conditions.”

Following authorization from the CMS, the healthcare survey specialist will create methods to gauge patient experience.

Lauren Massaro

Articles

Hospital Differences Explain Higher Mortality Among Black Patients With COVID-19, Study Finds

CMS Authorizes Press Ganey to Administer Primary Care First Patient Experience of Care Surveys