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

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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 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 1 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 physicians’ 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.

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Authors and Affiliations

  1. the Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Hospital, Boston, Mass

    Russell S. Phillips MD, Mary Beth Hamel MD, MPH & Roger B. Davis ScD

  2. the Division of Clinical Epidemiology, Department of Medicine, Beth Israel Hospital, Boston, Mass

    Joan M. Teno MD & Lee Goldman MD, MPH

  3. the UCLA School of Medicine, UCLA Medical Center, Los Angeles, Calif

    Paul Bellamy MD

  4. the Marshfield Medical Research Foundation/Marshfield Clinic, Marshfield, Wis

    Steven K. Broste MS & Humberto Vidaillet MD

  5. the Duke University Medical Center, Durham, NC

    Robert M. Califf MD & Lawrence H. Muhlbaier PhD

  6. Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio

    Alfred F. Connors Jr. MD

  7. the Dartmouth-Hitchcock Medical Center, Hanover, NH

    Joanne Lynn MD, MA

Authors
  1. Russell S. Phillips MD
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  2. Mary Beth Hamel MD, MPH
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  9. Lawrence H. Muhlbaier PhD
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  12. Lee Goldman MD, MPH
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the SUPPORT Investigators

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The opinions and findings contained in this manuscript are those of the authors and do not necessarily represent the views of the Robert Wood Johnson Foundation or their Board of Trustees.

Financial support for this study was provided by the Robert Wood Johnson Foundation.

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Phillips, R.S., Hamel, M.B., Teno, J.M. et al. Race, resource use, and survival in seriously III hospitalized adults. J Gen Intern Med 11, 387–396 (1996). https://doi.org/10.1007/BF02600183

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