Hospitals that receive high safety grades and score well on external safety measures do not provide better care to patients of color than lower-rated facilities, according to a study of more than 10 million patient records.
The research from Leapfrog Group and Urban Institute, which used 2019 discharge data from across 15 states, found that Black and Latino patients are more at risk of experiencing adverse safety events than white patients, regardless of a hospital’s Leapfrog Group ranking.
Twice a year, the Leapfrog Group releases safety grades on hospitals nationwide based on their self-reported data on safety performance and adverse events like medication errors, infections and surgery complications. The watchdog organization’s scores are considered a well-respected indicator of a hospital’s quality and safety for potential patients.
Across all hospitals, Black and Latino patients experienced 34% higher rates of sepsis after surgery than white patients, and Black patients experienced 51% higher rates of dangerous blood clots as surgery-related complications, the research found.
The findings point to a need for greater scrutiny on the intersection of patient safety and care inequity.
“This seems to be a symptom of structural racism across hospitals, systematically,” said Anuj Gangopadhyaya, an author of the report and senior research associate at the Urban Institute’s health policy center. “If we have the capacity to improve overall scores, we should have the capacity to reduce inequities among patient subgroups within our institutions.”
Rather than being satisfied with their performance on external quality and safety measures, hospitals need to reevaluate and update policies and programs to better address disparities in quality outcomes, Gangopadhyaya said. “As a hospital becomes ‘higher quality,’ you would expect disparities might uniformly go down across all patient groups, and that’s just not the case here,” he said.
All patients are at a lower risk of falls, infections and pressure ulcers in “A”-graded hospitals than in “C,” “D,” or “F”-graded hospitals. However, Black and Latino patients are not as safe as white patients in higher-ranked facilities.
The study found larger disparities between Black and white patients for rates of sepsis, hemorrhage and other adverse events related to surgery at Leapfrog’s “A” hospitals.
At “A” hospitals, the rate of perioperative hemorrhage in white patients was 2.01 cases per 1,000 at-risk discharges, compared with 2.80 cases for Black patients. Rates of perioperative pulmonary embolism or deep vein thrombosis were 2.87 cases and 4.22 cases, respectively.
Some health systems and industry stakeholders are beginning to address the challenges of eliminating disparities by paying closer attention to inequities in care and how they can vary by location, insurer, demographic and procedure.
It’s hard for hospitals to see how policies and years of systemic bias affect care for patients of color when quality measures and safety ratings don’t take equity into account, said Maulik Joshi, president and CEO at Meritus Health, a Hagerstown, Maryland-based system.
“Unless you know you have disparities, you can’t work to reduce the disparities,” Joshi said. “Hospitals and others are just not there yet, in looking at all of that consistently and reliably.”
At Meritus Health, leaders create teams to stratify data on high-level safety measures by race and conduct root cause analyses to determine why there are inequities in certain areas, he said. Then, team leaders test intervention strategies, which can include training on unconscious bias and care practices as well as making clinicians aware of systemwide disparity data.
In 2022, the Centers for Medicare and Medicaid Services launched its National Quality Strategy initiative, which aims to collect and analyze health equity data as part of the agency’s quality reporting programs.
Likewise, in 2021 the National Committee for Quality Assurance started stratifying its Healthcare Effectiveness Data and Information Set by race and ethnicity as a way to pressure health plans to address disparities in care and outcomes among their patient populations.
Because hospitals aren’t currently penalized by CMS or other entities for poor performance in treating patients of color, it is largely up to facilities to hold themselves accountable, Gangopadhyaya said.
“Hospitals need to make health equity a strategic priority for themselves and [decrease] institutional racism within their own organizations, potentially through physician training and educational programming,” he said.
