Abstract
OBJECTIVE: To examine the association between patient race and hospital resource use. DESIGN: Prospective cohort study. SETTING: Five geographically diverse teaching hospitals. PATIENTS: Patients were 9,105 hospitalized adults with one of nine illnesses associated with an average 6-month mortality of 50%. MEASUREMENTS AND MAIN RESULTS: Measures of resource use included: a modified version of the Therapeutic Intervention Scoring System (TISS): performance of any of five procedures (operation, dialysis, pulmonary artery catheterization, endoscopy, and bronchoscopy); and hospital charges, adjusted by the Medicare cost-to-charge ratio per cost center at each participating hospital. The median patient age was 65; 79% were white. 16% African- American, 3% Hispanic, and 2% other races; 47% died within 6 months. After adjusting for other sociodemographic factors, severity of illness, functional status, and study site, African-Americans were less likely to receive any of five procedures on study day 1 and 3 (adjusted odds ratio [OR] 0.70; 95% confidence interval [CI] 0.60, 0.81). In addition, African-Americans had lower TISS scores on study day I and 3 (OR 1.8; 95% CI -1.3, -2.4) and lower estimated costs of hospitalization (OR $2,805; 95% CI -$1,672, -$3.883). Results were similar after adjustment for patients' preferences and physician's prognostic estimates. Differences in resource use were less marked after adjusting for the specialty of the attending physician but remained significant. In a subset analysis, cardiologists were less likely to care for African-Americans with congestive heart failure (p < .001), and cardiologists used more resources (p <.001). After adjustment for other sociodemographic factors, severity of illness, functional status, and study site, survival was slightly better for African-American patients (hazard ratio 0.91; 95% CI 0.84, 0.98) than for white or other race patients. CONCLUSIONS: Seriously ill African-Americans received less resource-intensive care than other patients after adjustment for other sociodemographic factors and for severity of illness. Some of these differences may be due to differential use of subspecialists. The observed differences in resource use were not associated with a survival advantage for white or other race patients.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 387-396 |
| Number of pages | 10 |
| Journal | Journal of general internal medicine |
| Volume | 11 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jan 1 1996 |
| Externally published | Yes |
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Keywords
- African-Americans
- race
- resource use
- specialty care
- survival
ASJC Scopus subject areas
- Internal Medicine
Cite this
Race, resource use, and survival in seriously ill hospitalized adults. / Phillips, Russell S.; Homel, Mary Beth; Teno, Joan; Bellamy, Paul; Broste, Steven K.; Califf, Robert M.; Vidaillet, Humberto; Davis, Roger B.; Muhlbaier, Lawrence H.; Connors, Alfred F.; Lynn, Joanne; Goldman, Lee.
In: Journal of general internal medicine, Vol. 11, No. 7, 01.01.1996, p. 387-396.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Race, resource use, and survival in seriously ill hospitalized adults
AU - Phillips, Russell S.
AU - Homel, Mary Beth
AU - Teno, Joan
AU - Bellamy, Paul
AU - Broste, Steven K.
AU - Califf, Robert M.
AU - Vidaillet, Humberto
AU - Davis, Roger B.
AU - Muhlbaier, Lawrence H.
AU - Connors, Alfred F.
AU - Lynn, Joanne
AU - Goldman, Lee
PY - 1996/1/1
Y1 - 1996/1/1
N2 - OBJECTIVE: To examine the association between patient race and hospital resource use. DESIGN: Prospective cohort study. SETTING: Five geographically diverse teaching hospitals. PATIENTS: Patients were 9,105 hospitalized adults with one of nine illnesses associated with an average 6-month mortality of 50%. MEASUREMENTS AND MAIN RESULTS: Measures of resource use included: a modified version of the Therapeutic Intervention Scoring System (TISS): performance of any of five procedures (operation, dialysis, pulmonary artery catheterization, endoscopy, and bronchoscopy); and hospital charges, adjusted by the Medicare cost-to-charge ratio per cost center at each participating hospital. The median patient age was 65; 79% were white. 16% African- American, 3% Hispanic, and 2% other races; 47% died within 6 months. After adjusting for other sociodemographic factors, severity of illness, functional status, and study site, African-Americans were less likely to receive any of five procedures on study day 1 and 3 (adjusted odds ratio [OR] 0.70; 95% confidence interval [CI] 0.60, 0.81). In addition, African-Americans had lower TISS scores on study day I and 3 (OR 1.8; 95% CI -1.3, -2.4) and lower estimated costs of hospitalization (OR $2,805; 95% CI -$1,672, -$3.883). Results were similar after adjustment for patients' preferences and physician's prognostic estimates. Differences in resource use were less marked after adjusting for the specialty of the attending physician but remained significant. In a subset analysis, cardiologists were less likely to care for African-Americans with congestive heart failure (p < .001), and cardiologists used more resources (p <.001). After adjustment for other sociodemographic factors, severity of illness, functional status, and study site, survival was slightly better for African-American patients (hazard ratio 0.91; 95% CI 0.84, 0.98) than for white or other race patients. CONCLUSIONS: Seriously ill African-Americans received less resource-intensive care than other patients after adjustment for other sociodemographic factors and for severity of illness. Some of these differences may be due to differential use of subspecialists. The observed differences in resource use were not associated with a survival advantage for white or other race patients.
AB - OBJECTIVE: To examine the association between patient race and hospital resource use. DESIGN: Prospective cohort study. SETTING: Five geographically diverse teaching hospitals. PATIENTS: Patients were 9,105 hospitalized adults with one of nine illnesses associated with an average 6-month mortality of 50%. MEASUREMENTS AND MAIN RESULTS: Measures of resource use included: a modified version of the Therapeutic Intervention Scoring System (TISS): performance of any of five procedures (operation, dialysis, pulmonary artery catheterization, endoscopy, and bronchoscopy); and hospital charges, adjusted by the Medicare cost-to-charge ratio per cost center at each participating hospital. The median patient age was 65; 79% were white. 16% African- American, 3% Hispanic, and 2% other races; 47% died within 6 months. After adjusting for other sociodemographic factors, severity of illness, functional status, and study site, African-Americans were less likely to receive any of five procedures on study day 1 and 3 (adjusted odds ratio [OR] 0.70; 95% confidence interval [CI] 0.60, 0.81). In addition, African-Americans had lower TISS scores on study day I and 3 (OR 1.8; 95% CI -1.3, -2.4) and lower estimated costs of hospitalization (OR $2,805; 95% CI -$1,672, -$3.883). Results were similar after adjustment for patients' preferences and physician's prognostic estimates. Differences in resource use were less marked after adjusting for the specialty of the attending physician but remained significant. In a subset analysis, cardiologists were less likely to care for African-Americans with congestive heart failure (p < .001), and cardiologists used more resources (p <.001). After adjustment for other sociodemographic factors, severity of illness, functional status, and study site, survival was slightly better for African-American patients (hazard ratio 0.91; 95% CI 0.84, 0.98) than for white or other race patients. CONCLUSIONS: Seriously ill African-Americans received less resource-intensive care than other patients after adjustment for other sociodemographic factors and for severity of illness. Some of these differences may be due to differential use of subspecialists. The observed differences in resource use were not associated with a survival advantage for white or other race patients.
KW - African-Americans
KW - race
KW - resource use
KW - specialty care
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=9444288678&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=9444288678&partnerID=8YFLogxK
U2 - 10.1007/BF02600183
DO - 10.1007/BF02600183
M3 - Article
C2 - 8842929
AN - SCOPUS:9444288678
VL - 11
SP - 387
EP - 396
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
SN - 0884-8734
IS - 7
ER -