Studies of racial disparities in hospital-level patient safety outcomes typically apply a race-common approach to risk adjustment. Risk factors specific to a minority population may not be identified in a race-common analysis if they represent only a small percentage of total cases. This study identified patient comorbidities and characteristics associated with the likelihood of a venous catheter–related bloodstream infection (Agency for Healthcare Research and Quality Patient Safety Indicator 7 [PSI7]) separately for blacks and whites using race-specific logistic regression models. Hospitals were ranked by the racial disparity in PSI7 and segmented into 4 groups. The analysis identified both black- and white-specific risk factors associated with PSI7. Age showed race-specific reverse association, with younger blacks and older whites more likely to have a PSI7 event. These findings suggest the need for race-specific covariate adjustments in patient outcomes and provide a new context for examining racial disparities.
KaafaraniHMRosenAK. Using administrative data to identify surgical adverse events: an introduction to the patient safety indicators. Am J Surg. 2009;198(5, suppl):S63-S68.
3.
MillerMRElixhauserAZhanCMeyerGS. Patient safety indicators: using administrative data to identify potential patient safety concerns. Health Serv Res. 2001;36(6, pt 2):110-132.
4.
NaessensJMCampbellCRShahN. Effect of illness severity and comorbidity on patient safety and adverse events. Am J Med Qual. 2012;27:48-57.
5.
RivardPELutherSLChristiansenCL. Using patient safety indicators to estimate the impact of potential adverse events on outcomes. Med Care Res Rev. 2008;65:67-87.
6.
RomanoPSGeppertJJDaviesSMillerMRElixhauserAMcDonaldKM. A national profile of patient safety in US hospitals. Health Aff (Millwood). 2003;22:154-166.
7.
RosenAKZhaoSRivardP. Tracking rates of patient safety indicators over time: lessons from the Veterans Administration. Med Care. 2006;44:850-861.
8.
CoffeyRMAndrewsRMMoyE. Racial, ethnic, and socioeconomic disparities in estimates of AHRQ patient safety indicators. Med Care. 2005;43(3, suppl):I48-I57.
9.
MeterskyMLHuntDRKlimanR. Racial disparities in the frequency of patient safety events: results from the National Medicare Patient Safety Monitoring System. Med Care. 2011;49:504-510.
10.
Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2003.
11.
FryDEPineMJonesBLMeimbanRJ. Patient characteristics and the occurrence of never events. Arch Surg. 2010;145:148-151.
12.
WillJCValderramaALYoonPW. Preventable hospitalizations for congestive heart failure: establishing a baseline to monitor trends and disparities. Prev Chronic Dis. 2012;9:E85.
13.
Agency for Healthcare Research and Quality. Diabetes disparities among racial and ethnic minorities. http://www.ahrq.gov/research/diabdisp.htm. Accessed July 26, 2012.
14.
EsperAMMossMLewisCANisbetRManninoDMMartinGS. The role of infection and comorbidity: factors that influence disparities in sepsis. Crit Care Med. 2006;34:2576-2582.
15.
Hasnain-WyniaRBakerDWNerenzD. Disparities in health care are driven by where minority patients seek care: examination of the hospital quality alliance measures. Arch Intern Med. 2007;167:1233-1239.
16.
PippinsJRFitzmauriceGMHaasJS. Hospital characteristics and racial disparities in hospital mortality from common medical conditions. J Natl Med Assoc. 2007;99:1030.
17.
VartakSWardMMVaughnTE. Do postoperative complications vary by hospital teaching status?Med Care. 2008;46:25-32.
18.
JhaAKStaigerDOLucasFLChandraA. Do race-specific models explain disparities in treatments after acute myocardial infarction?Am Heart J. 2007;153:785-791.
19.
YuHGreenbergMDHavilandAMFarleyDO. “Canary measures” among the AHRQ patient safety indicators. Am J Med Qual. 2009;24:465-473.
ElixhauserASteinerCHarrisDRCoffeyRM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8-27.
23.
BarnettAGBeyersmannJAllignolARosenthalVDGravesNWolkewitzM. The time-dependent bias and its effect on extra length of stay due to nosocomial infection. Value Health. 2011;14:381-386.
24.
ForsterAJTaljaardMOakeNWilsonKRothVvan WalravenC. The effect of hospital-acquired infection with Clostridium difficile on length of stay in hospital. CMAJ. 2012;184:37-42.
25.
GaskinDJSpencerCSRichardPAndersonGFPoweNRLaVeistTA. Do hospitals provide lower-quality care to minorities than to whites?Health Affairs (Millwood). 2008;27:518-527.
26.
ShroffGRTaylorALColvin-AdamsM. Race-related differences in heart failure therapies: simply black and white or shades of grey?Curr Cardiol Rep. 2007;9: 178-181.
27.
CarsonPZiescheSJohnsonGCohnJN. Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials. Vasodilator-Heart Failure Trial Study Group. J Card Fail. 1999;5:178-187.
28.
YancyCW. Heart failure in African Americans: a cardiovascular engima. J Card Fail. 2000;6:183-186.
29.
TaylorALWrightJTJr. Should ethnicity serve as the basis for clinical trial design? Importance of race/ethnicity in clinical trials: lessons from the African-American Heart Failure Trial (A-HeFT), the African-American Study of Kidney Disease and Hypertension (AASK), and the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Circulation. 2005;112:3654-3660; discussion 3666.
30.
MathewJWittesJMcSherryF. Racial differences in outcome and treatment effect in congestive heart failure. Am Heart J. 2005;150:968-976.
31.
BalesCWRitchieCS. Sarcopenia, weight loss, and nutritional frailty in the elderly. Annu Rev Nutr. 2002;22:309-323.
32.
MartonKISoxHCJrKruppJR. Involuntary weight loss: diagnostic and prognostic significance. Ann Intern Med. 1981;95:568-574.
