Changes in patterns of racial disparities in attending low-mortality hospitals and outcomes among patients with stroke.

AIM: This exploratory study evaluates patterns of care relative to frequency of admission to high quality hospitals and mortality risk for patients with stroke among varying ethnic groups.

METHODS: Information from 273,532 adult patients with stroke was abstracted from the 2000 and 2006 National Inpatient Sample. Race/ethnicity was categorized as White, African American, Hispanic/Latino, or Asian/Pacific Islander. Hospitals were ranked based on the risk-adjusted overall stroke mortality rate and then divided into four groups based on the quartiles of the ranking. Changes in disparities in attending the four groups of hospitals across race/ethnicity from 2000 to 2006 were examined. Disparities in mortality risk among patients in four racial/ethnic groups were also examined.

RESULTS: In 2006 as compared to 2000, African American and Hispanic/Latino patients were increasingly likely to be admitted to high-quality hospitals. Disparities related to outcomes did not vary in a predictable manner during this period. Relatively low likelihood of admission to high-quality hospitals persisted among Asian/Pacific Islanders.

CONCLUSIONS: Multiple efforts related to expanded access to care may have contributed to greater likelihood of admission to high-quality hospitals for African American and Hispanic patients, but these efforts do not seem to have affected Asian/Pacific Islander patients. Further research is needed to explore mechanisms for improving outcomes in high-risk populations. Policies should continue to support healthcare quality improvement efforts that have shown positive effects on outcomes of patients of all racial/ethnic groups. Programs that help Asian/ Pacific Islander patients to identify and attend high-quality hospitals should also be encouraged.