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Black patients receive poorer-quality care than whites

Quality Improvement Monitor, September 17, 2004

Black patients generally receive lower-quality healthcare in the U.S. than white patients, according to research published in the New England Journal of Medicine August 5 (Vol. 351, No. 6).

Researchers at Memorial Sloan-Kettering Cancer Center and the Center for Studying Health System Change performed a cross-sectional analysis of 150,391 "evaluation and management" visits by black and white Medicare beneficiaries aged 65 years or older who were seen by 4,355 primary care physicians.

They found that, to a large extent, black patients received their care from a subgroup of physicians whose qualifications or resources were inferior to those of physicians who generally treated white patients.

In addition, researchers found that physicians treating black patients were:

• less likely to be board certified (77%) than physicians treating white patients (86%)

• more likely (28%) to report that they were unable to provide high-quality care to all of their patients than physicians treating white patients (19%)

• experiencing greater difficulty obtaining access for their patients to high-quality subspecialists (24% vs. 18%), high-quality diagnostic imaging (24% vs. 17%) , and nonemergency admission to the hospital (49% vs. 37%).

The findings reflected the characteristics of healthcare in the community where the patients were treated.

"The care of black and white patients rests to a large extent in the hands of different physicians, and health disparities may be driven by these two groups of physicians differing in their ability to provide high-quality care because of community differences such as the availability of important health care services," says Hoangmai Pham, MD, MPH, a coauthor and senior health researcher at Washington- based Center for Studying Health System Change.

In prior research, lead author Peter Bach, MD, of the Department of Epidemiology and Biostatistics at the New York-based Memorial Sloan-Kettering, linked lower rates of cancer survival to the poor quality healthcare that black patients receive prior to a cancer diagnosis.

"It seems clear that if we are to reach the goals of eliminating racial and ethnic disparities in healthcare, we must begin by examining the resources available in primary care to coordinate a patient's medical treatment," says Bach. "The physicians who treat black patients face several obstacles, in that they do not have access to the best local services or connections with other specialists."

--Wendy Johnson
wjohnson@hcpro.com

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