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Black, Hispanic hospital patients are more likely to have complications, Leapfrog Group finds

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Those patients had higher rates of sepsis and respiratory failure, according to a study of millions of records. Missy Danforth of The Leapfrog Group spoke with us about the findings.

Black and Hispanic patients face greater risks of adverse events in hospitals, particularly after surgical procedures, according to a new analysis from The Leapfrog Group.

The organization, which produces regular reports on hospital safety, found Black and Hispanic patients were more likely to have complications, even at hospitals with higher grades for patient safety. Patients relying on Medicare and Medicaid also had a greater likelihood of more serious complications, the report found.

The Leapfrog Group teamed with the Urban Institute to produce the report, which was released Wednesday. They examined 11 patient safety issues, including blood clots and sepsis after surgery.

Missy Danforth, vice president of health care ratings at The Leapfrog Group and a co-author of the report, tells Chief Healthcare Executive® that the findings are disturbing, given the serious nature of some of the complications.

“These aren't some things that just might lengthen your stay in the hospital,” Danforth says. “In some cases, these are things that could be fatal.”

The analysis found disparities among minority groups in outcomes in five of the 11 patient safety areas.

“It’s been kind of a sobering exercise,” Danforth says.

(See part of our conversation with Missy Danforth in this video. The story continues below.)

Preventable complications

Black patients suffered a substantially higher rate of complications than white patients. Black patients had a 51% higher rate of blood clots after surgery; a 34% higher rate of sepsis after surgery; and a 17% higher rate of respiratory failure.

Black patients also had a greater likelihood of suffering severe pressure ulcers. Danforth notes that the analysis only focused on patients who developed a pressure ulcer in the hospital; the study did not include patients who may have been transferred from another facility with a pressure ulcer.

“They're really deep wounds that sometimes you can actually see through to the bone,” Danforth says. “So these are painful. And these are entirely preventable.”

Hispanic patients were also 34% more likely to develop sepsis after surgery than white patients, and Hispanic patients had a 21% higher rate of respiratory failure after surgery.

The analysis examined more than 10 million patient records, utilizing 2019 hospital discharge data from 15 states, including states with diverse populations such as California, New Jersey and Florida. The data was culled from the federal Agency for Healthcare Research & Quality.

The report found that hospitals with higher safety ratings - the “A” and “B” grades - reported significantly fewer complications across all groups. But even in those hospitals, Black and Hispanic patients were more likely to have adverse events, the study found.

Disparities among payers

Patients relying on Medicare or Medicaid were more likely to suffer complications than those covered by commercial insurance, the report stated. Medicare patients had higher rates of complications in 10 of the 11 patient safety areas examined, including pulmonary embolisms, respiratory failure and postoperative sepsis.

Danforth says the disparities among patients with Medicare or Medicaid may have been the most surprising.

“I think one thing that probably jumped out at us that hasn't gotten quite as much attention, actually, were the payer disparities,” Danforth says.

Anuj Gangopadhyaya, senior research associate in the Health Policy Center at the Urban Institute, said the disparities among Medicare and Medicaid patients points to “a systemic issue impacting the quality of care.”

“Hospitals should recognize these disparities and ensure resources are devoted to reducing adverse safety events among patient groups at the highest risk,”  Gangopadhyaya said in a statement.

‘Look inward’

Danforth says she hopes the analysis prods more hospitals and health systems to look at their own outcomes and identify areas where they can do better. Hospitals can look to guidance from the Institute for Healthcare Improvement to pursue better outcomes, she says.

“The main takeaway we hope hospitals will get from this is to sort of take a look at this national picture, but then look inward, and really try to do more of a local risk assessment to see the extent at which these patient safety indicators might be real problems for different patients at their own hospital,” Danforth says.

Patients should understand that even though disparities exist at all levels, the data indicates that the risk of complications remains lower at hospitals with higher safety grades, Danforth says.

Hospitals and health systems sometimes find patients reluctant to share race and ethnicity data, she acknowledges. Providers should encourage patients to disclose data and help patients understand why it’s useful to have better information on race and ethnicity in order to close disparities and improve care.

She pointed to Henry Ford Health’s “Why We Ask” campaign to help patients see the need for more precise data to improve care.

“We’d also love to see … more communication from hospitals and registration staff about why they're asking about race and ethnicity, and how that information can be used by the hospital, to make sure that other patients are getting the same high quality care,” Danforth says.

Hospitals have seen significant increases in some infections during the COVID-19 pandemic, according to The Leapfrog Group’s spring hospital safety grades.

Federal officials have also said the COVID-19 pandemic eroded gains in patient safety.

The Leapfrog Group’s new report focused on data from 2019, the year before the COVID-19 pandemic. But Danforth says it’s possible the organization will perform additional studies to evaluate disparities in care among minority groups, particularly in the pandemic years.

“I think that now that we've done this analysis once, there are additional questions we’ll want to answer,” Danforth says.


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