Yale study finds minorities less likely to use high-volume hospitals

Yale University Press Release

New Haven — African Americans are much less likely to receive surgical treatment at hospitals and from physicians who perform high volumes of specialized procedures, a new study led by the Yale School of Public Health has found. The study is published in Archives of Surgery, a journal of the American Medical Association.

The researchers examined tens of thousands of patients and found that African Americans were significantly less likely than their white peers to get surgery for many potentially life-threatening conditions at hospitals and by surgeons who performed the highest number of procedures for various cancers, cardiovascular diseases and hip replacement.

"Evidence suggests that the more procedures physicians and hospitals perform for a given condition, the better they will be at doing it," said Andrew J. Epstein, Ph.D., assistant professor at School of Public Health and the study's lead author. "Our study shows that many minorities with serious medical conditions are receiving treatment in hospitals and with surgeons who have performed fewer of the procedures needed to address their medical conditions."

Epstein, along with Mark J. Schlesinger, Ph.D., professor at the School of Public Health, and Bradford H. Gray, Ph.D., of the Urban Institute, studied 133,821 patients who underwent one of 10 surgical procedures in New York City. They found that for nine of these procedures, African Americans were less likely than white patients to be treated by both a high-volume hospital and a high-volume surgeon. Those of Asian descent were significantly less likely to use high-volume hospitals and surgeons for five of the procedures studied, and Hispanics were less likely to use high-volume hospitals and surgeons for four of the 10 procedures, Epstein explained.

"As calls for making the health care system more consumer-directed grow louder, these findings suggest that minority patients may need additional resources and assistance in finding and accessing high-quality medical providers," Epstein said.

The researchers found that the white patients in the study were generally older and lived in the city's wealthier enclaves. They were also more likely to be covered by Medicare than their peers in the other groups and less likely to be without health insurance. The significant differences across racial/ethnic groups in the use of high-volume hospitals and surgeons persisted after adjusting for these and other factors.

Epstein said that future research will concentrate on identifying the causes of these disparities.

Yale New Haven Hospital (YNHH), part of Yale New Haven Health, is a nationally recognized, 1,541-bed, not-for-profit hospital serving as the primary teaching hospital for the Yale School of Medicine (YSM). Founded as the fourth voluntary hospital in the U.S. in 1826, today, YNHH has two New Haven-based campuses, and also includes Yale New Haven Children's Hospital, Yale New Haven Psychiatric Hospital and Smilow Cancer Hospital. YNHH has received Magnet designation from the American Nurses Credentialing Center, the nation’s highest honor of nursing excellence. YNHH has a combined medical staff of about 4,500 university and community physicians practicing in more than 100 specialties. www.ynhh.org