Leapfrog: Disparities persist at top-graded hospitals

Racial disparities in rates of adverse events persist even at the top-rated hospitals for safety, a new report from The Leapfrog Group shows. 

The Leapfrog Group assigns letter grades to nearly 3,000 acute care general hospitals across the U.S. every fall and spring. The safety grades are recognized for being the only hospital ratings program solely based on hospitals' ability to protect patients from preventable errors, accidents, injuries and infections. 

However, "little is known about the association between Hospital Safety Grades and the delivery of safe care specific to a patient's racial-ethnic background or insurance," researchers from Leapfrog and the Urban Institute said in the report published June 7. "Further, no evidence indicates whether safer overall care is associated with narrowing disparities in patient safety among patients with different racial-ethnic backgrounds or among patients with different types of insurance."

Thus, they conducted an analysis based on 2019 hospital discharge data from 15 states, including more than 10 million patient records. They compared the rate of 11 adverse safety events by racial and ethnic background, as well as by payer type. Overall, care was safer for all racial groups at higher-graded hospitals, but Black and Hispanic patients were still at increased risk of certain adverse safety events compared to white patients, even at "A" and "B" graded hospitals. 

The findings showed: 

  • Black patients were more likely to experience surgery-related complications than white patients. They experienced 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. 
  • Across all hospital safety grades, Black patients faced significantly higher risks of stage 3 and 4 pressure ulcers.
  • Relative to white patients, Hispanic patients also experienced a higher risk of sepsis (34 percent) and respiratory failure (21 percent) after surgery, "and these differences remain significant at higher-graded hospitals," researchers said
  • Compared to those with private insurance, patients covered by Medicare or Medicaid experienced higher rates of adverse safety events. 

"Leapfrog Hospital Safety Grades, therefore, cannot be used to convey information on the underlying disparity in safe inpatient care," the report said. "From a policy perspective, our findings indicate that Black and Hispanic patients and, separately, patients with public insurance would benefit from better tools to help them assess the additional risk that may accompany a hospital stay," in addition to the need for hospitals to devote adequate resources and interventions to eliminate disparities. 

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