Journal of General Internal Medicine

, Volume 11, Issue 7, pp 387–396 | Cite as

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

  • Russell S. Phillips
  • Mary Beth Hamel
  • Joan M. Teno
  • Paul Bellamy
  • Steven K. Broste
  • Robert M. Califf
  • Humberto Vidaillet
  • Roger B. Davis
  • Lawrence H. Muhlbaier
  • Alfred F. ConnorsJr.
  • Joanne Lynn
  • Lee Goldman
  • the SUPPORT Investigators
Original Articles


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.

Key words

resource use race African-Americans survival specialty care 


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Copyright information

© Society of General Internal Medicine 1996

Authors and Affiliations

  • Russell S. Phillips
    • 1
  • Mary Beth Hamel
    • 1
  • Joan M. Teno
    • 2
  • Paul Bellamy
    • 3
  • Steven K. Broste
    • 4
  • Robert M. Califf
    • 5
  • Humberto Vidaillet
    • 4
  • Roger B. Davis
    • 1
  • Lawrence H. Muhlbaier
    • 5
  • Alfred F. ConnorsJr.
    • 6
  • Joanne Lynn
    • 7
  • Lee Goldman
    • 2
  • the SUPPORT Investigators
    • 8
  1. 1.the Division of General Medicine and Primary Care, Department of MedicineBeth Israel HospitalBoston
  2. 2.the Division of Clinical Epidemiology, Department of MedicineBeth Israel HospitalBoston
  3. 3.the UCLA School of MedicineUCLA Medical CenterLos Angeles
  4. 4.the Marshfield Medical Research Foundation/Marshfield ClinicMarshfield
  5. 5.the Duke University Medical CenterDurham
  6. 6.Case Western Reserve UniversityMetroHealth Medical CenterCleveland
  7. 7.the Dartmouth-Hitchcock Medical CenterHanover
  8. 8.the SUPPORT Coordinating CenterGeorge Washington UniversityWashington, DC

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