Racial disparities in the quality of health care are well recognized in the United States. Multiple factors drive this disparity gap in quality, but few strategies have proven successful in decreasing the gap. Quality improvement has been heralded as a solution to these disparities. If everybody gets high‐quality care through global quality improvement, then racial disparities should decrease. There are concerns that if only the “haves” in health care are able to improve through quality improvement, the “have nots” will be left behind, and the disparity gap may increase. We examined the effects of HospitalCompare public reporting on the disparity gap among UHC participating institutions at the institution level.
UHC participating institutions were defined as white if >60% white patients or nonwhite if <60% white patients. Racial assignment used UHC administrative data. Institutional performance on meeting 11 quality measures for myocardial infarction and congestive heart failure were assessed before and after public reporting using data from Hospital‐Compare. Performance was estimated per year for each of the condition–measure combinations. Naive rate ratios were estimated with 95% confidence intervals (ignoring within‐hospital correlations over time). Final analyses were carried out using random intercept Poisson regression, which included the variables white, time, and their interaction. The white × time interaction was assessed using the likelihood ratio test (LRT). Also, after the interaction was found not significant, the LRT test was performed to test for trends over time.
Most measures had improved performance in both white and nonwhite institutions. Before public reporting, white institutions performed better than nonwhite institutions on 9 of 11 measures. After controlling for hospital correlations over time, white hospitals outperformed nonwhite hospitals on 5 of 11 measures. The greatest difference was seen in door‐to‐balloon time (white hospitals’ performance rate ratio, 1.35; 95% CI, 1.13–1.61; relative to nonwhite hospitals). After public reporting, the disparity gap disappeared in 4 of 5 of these measures. In door‐to‐balloon time, the rate ratio was 1.00 after public reporting. In no instance was there a worsening of the disparity gap.
Significant racial disparities exist at baseline in process‐of‐care measures for 2 common cardiac conditions. Among UHC institutions, post–public reporting performance was higher than preper‐formance. This improved overall improvement led to either no significant change in, a reduction in, or elimination of the baseline disparity gap. This study suggests that public reporting tied to financial incentives may lead to improved overall care while lowering the racial disparity gap through local quality improvement efforts.
C. T. Whelan ‐ none; R. A. Durazo‐Arvizu ‐ none; G. Steinhardt ‐ none; R. S. Cooper ‐ none