Even At Top Hospitals, Racial Health Disparities in Patient Safety Are Steep

Even the highest-performing hospitals see racial health disparities in adverse patient safety events, with a new report from The Leapfrog Group and Urban Institute showing that gaps persist across top- and bottom-rated hospitals.

Although patient safety was generally higher for all racial groups in the top-rated hospitals, disparities persisted, according to the report, which was obtained via email.

Examining racial health disparities has become a top priority for the healthcare industry as it eyes a future of total health equity. Understanding where gaps exist will be key to addressing and closing those gaps, experts have asserted.

This latest study looked at differences in adverse patient safety events stratified both by race and by hospital rating as defined by The Leapfrog Group’s regular patient safety grades (A, B, or C/D/F hospitals). Using 2019 hospital discharge records from 15 states representing more than 10 million patients, the researchers found that equitable patient safety outcomes are elusive.

Regardless of hospital rating, White patients were less likely to experience an adverse patient safety event than their Black and Hispanic peers.

Indeed, “A” hospitals did have overall better patient safety scores, with all patients regardless of race being less likely to experience an adverse patient safety event in these facilities. “B” hospitals also had better patient safety scores than “C/D/F” hospitals regardless of patient race.

These results were unsurprising; better-rated hospitals should have better patient safety scores. Good performance in patient safety is, in part, how these hospitals got their A and B grades.

However, when broken down by race, A and B hospitals had similar problems as C/D/F hospitals. These top-rated hospitals also had marked racial health disparities in rates of patient safety incidents. These disparities were around even across all hospital grade ratings.

For example, Black patients were more likely to experience the surgery-related complications that the researchers examined. Particularly, they faced 34 percent higher rates of sepsis after surgery, 51 percent higher rates of dangerous blood clots after surgery, and 17 percent higher rates of respiratory failure after surgery.

Moreover, Black patients had a higher risk of Stage 3 and 4 pressure ulcers, or bed sores that have progressed to become debilitating or deadly.

Hispanic patients saw similar patient safety risks, with the researchers noting a higher risk of experiencing sepsis and respiratory failure after surgery. Although higher-rated hospitals have smaller disparities in these areas, the researchers asserted that those gaps are still significant.

The researchers also looked at patient safety disparities across payer types, noting that patients with private insurance were less likely to experience an adverse patient safety event compared to those with Medicare or Medicaid. This was consistent across all hospitals regardless of Leapfrog Group rating.

The consistency of health disparities across all hospital rating grades indicates that The Leapfrog Group reports “cannot be used to convey information on the underlying disparity in safe inpatient care,” the researchers said. That means patients who fall into the groups facing more adverse events may need additional tools to help with care access decision-making.

“While publicly available hospital quality information is a good indication of the average quality of care a hospital delivers, this study illustrates that some patients systematically receive less safe care,” the research team wrote.

“Providing Hospital Safety Grades by patient racial and ethnic subgroups provides a clear solution, but we note that this may not be feasible for small patient subgroups with too few discharge observations from which to construct a reliable measure score. Nonetheless, a public-facing Hospital Safety Grade by patient racial and ethnic group may incentivize hospitals to narrow existing disparities.”