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Minorities, uninsured less likely to receive care at high-volume hospitals

Compared to white patients, black, Asian and Hispanic patients and those who are uninsured are less likely to undergo complex surgery at high-volume hospitals, which have been associated with better outcomes, according to a study in the October 25 issue of JAMA.

Efforts to improve the quality of surgical care in the United States have led many organizations to advocate the use of high-volume hospitals for certain procedures, since a number of studies have reported of a direct volume-outcome relationship for certain procedures, with patients at high-volume hospitals consistently having better outcomes. It appears there are important differences in the racial and socioeconomic status of patients who receive care at high- and low-volume hospitals, according to background information in the article. These differences may affect the ability to access or receive care at a high-volume hospital.

Jerome H. Liu, M.D., M.S.H.S., of the David Geffen School of Medicine at the University of California-Los Angeles, and colleagues conducted a study to determine whether the use of high-volume hospitals varies by race/ethnicity or insurance status in a broad population of patients undergoing complex surgical care. The researchers examined patient characteristics and use of high-volume hospitals across 10 hospital-based procedures with known volume-outcome relationships among Californians during a 5-year period (2000-2004), collecting data from California's Office of Statewide Health Planning and Development patient discharge database.

The procedures included elective abdominal aortic aneurysm repair, coronary artery bypass grafting, carotid endarterectomy, esophageal cancer resection, hip fracture repair, lung cancer resection, cardiac valve replacement, coronary angioplasty, pancreatic cancer resection, and total knee replacement.

According to this database, a total of 719,608 patients received 1 of the 10 operations. The researchers found that "
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Source:JAMA and Archives Journals


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