Race, resource use, and survival in seriously ill hospitalized adults

Russell S. Phillips, Mary Beth Homel, Joan Teno, Paul Bellamy, Steven K. Broste, Robert M. Califf, Humberto Vidaillet, Roger B. Davis, Lawrence H. Muhlbaier, Alfred F. Connors, Joanne Lynn, Lee Goldman

Research output: Contribution to journalArticle

58 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)387-396
Number of pages10
JournalJournal of general internal medicine
Volume11
Issue number7
DOIs
StatePublished - Jan 1 1996
Externally publishedYes

Fingerprint

African Americans
Survival
Confidence Intervals
Odds Ratio
Costs and Cost Analysis
Swan-Ganz Catheterization
Hospital Charges
Physicians
Patient Preference
Bronchoscopy
Critical Care
Medicare
Hispanic Americans
Teaching Hospitals
Endoscopy
Dialysis
Hospitalization
Cohort Studies
Heart Failure
Prospective Studies

Keywords

  • African-Americans
  • race
  • resource use
  • specialty care
  • survival

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Phillips, R. S., Homel, M. B., Teno, J., Bellamy, P., Broste, S. K., Califf, R. M., ... Goldman, L. (1996). Race, resource use, and survival in seriously ill hospitalized adults. Journal of general internal medicine, 11(7), 387-396. https://doi.org/10.1007/BF02600183

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 journalArticle

Phillips, RS, Homel, MB, Teno, J, Bellamy, P, Broste, SK, Califf, RM, Vidaillet, H, Davis, RB, Muhlbaier, LH, Connors, AF, Lynn, J & Goldman, L 1996, 'Race, resource use, and survival in seriously ill hospitalized adults', Journal of general internal medicine, vol. 11, no. 7, pp. 387-396. https://doi.org/10.1007/BF02600183
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. / Race, resource use, and survival in seriously ill hospitalized adults. In: Journal of general internal medicine. 1996 ; Vol. 11, No. 7. pp. 387-396.
@article{9208dd0930ea43628f55e8e2bc9002fd,
title = "Race, resource use, and survival in seriously ill hospitalized adults",
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.",
keywords = "African-Americans, race, resource use, specialty care, survival",
author = "Phillips, {Russell S.} and Homel, {Mary Beth} and Joan Teno and Paul Bellamy and Broste, {Steven K.} and Califf, {Robert M.} and Humberto Vidaillet and Davis, {Roger B.} and Muhlbaier, {Lawrence H.} and Connors, {Alfred F.} and Joanne Lynn and Lee Goldman",
year = "1996",
month = "1",
day = "1",
doi = "10.1007/BF02600183",
language = "English (US)",
volume = "11",
pages = "387--396",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",
number = "7",

}

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

VL - 11

SP - 387

EP - 396

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

IS - 7

ER -