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Critical care improvements may differ depending on a hospital's patient population

There was a 2% drop in ICU deaths at non-minority hospitals, but the same improvement rate was not seen at minority-serving hospitals.

Jeff Lagasse, Associate Editor

Racial disparities have occurred across a range of healthcare environments, sometimes extending into the highest levels of care. A new study led by researchers at Beth Israel Deaconess Medical Center reveals that while critical care outcomes in intensive care units steadily improved over a decade at hospitals with few minority patients, ICUs with a more diverse patient population did not.

Published in the American Journal of Respiratory and Critical Care Medicine, the findings reveal that the gap is most apparent for critically ill African-American patients.

WHAT'S THE IMPACT

Under the microscope were trends in ICU mortality and length of stay from 2006 to 2016 in more than 200 hospitals across the U.S. To examine differences in critical care outcomes across hospitals, the team compared the data between two types of institutions. For the purpose of the study, hospitals with a greater than 25% African-American and/or Hispanic ICU patient census were defined as minority-serving hospitals, while those with fewer were identified as non-minority hospitals.

The team found a steady annual decline of 2% in ICU deaths at non-minority hospitals; however, the same improvement in mortality rate was not seen at minority-serving hospitals. Minority-serving hospitals also reported longer lengths of ICU stay and critical illness hospitalizations than non-minority hospitals.

In addition to the disparity for all ICU patients seen in minority-serving hospitals, the researchers observed a particularly stark difference in care for critically ill African-American patients. African-Americans treated at non-minority hospitals experienced a 3% decline in mortality each year, compared to no decline in mortality when treated at minority-serving hospitals.

While the study does not determine whether the outcomes at minority-serving hospitals are due to differences in hospital resources and practices or a systemic disparity of these patient populations, the findings highlight the profound obstacles faced by minorities and minority-serving hospitals.

THE LARGER TREND

Racial disparities exist in many different facets of healthcare, including preventative care. Research published in 2018 found that Medicare patients nationwide have low rates of preventive care visits, with the lowest rates found in older adults of minority race/ethnicity.

Lower use of the Medicare annual wellness visit by non-white patients is partially explained by income and education -- suggesting that the difference is related to factors associated with racial and ethnic inequality.

The disparities even extend to the frequency with which patient portals are used. Removing the barriers of access to technology does not close the digital divide for African American and older patients, 2019 research found, with African American patients using patient portals 40% less than white patients.

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com