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Racial Disparity Seen in Trauma Center Mortality Rates

 |  By John Commins  
   September 12, 2013

Several mechanisms "end up leading to minority and uninsured patients having a higher death rate after trauma and I think that the hospital that they go to certainly plays a major role," says the lead author of a study that analyzed records from the National Trauma Data Bank.

 


Adil H. Haider, MD, trauma surgeon and associate professor of surgery at the Johns Hopkins University School

More than 80% of trauma centers that treat mostly minority patients have higher death rates than do trauma centers that treat mostly white and insured patients, a Johns Hopkins study shows.

The same study also found, however, that trauma patients of all races are 40% less likely to die if they are treated at hospitals with lower mortality rates, regardless of the severity of their injuries.

"Disparity issues are never simple," says the study's lead author Adil H. Haider, MD, a trauma surgeon and associate professor of surgery at the Johns Hopkins University School of Medicine. "There are several mechanisms that end up leading to minority and uninsured patients having a higher death rate after trauma and I think that the hospital that they go to certainly plays a major role into it. Certainly what this data shows is that not all hospitals are equal."

The findings detailed in an article published in the October issue of Annals of Surgery are based on an analysis of records from the National Trauma Data Bank. Haider and his team classified 181 trauma centers across the nation into three categories and found 86 hospitals with lower-than-expected death rates; six with average death rates; and 89 with higher-than-expected death rates.

Researchers found that 27 of the trauma centers serve a population that is more than 50% minority, while 154 have patients who are mostly white. Of the trauma centers that serve predominantly minority patients 81.5% were classified as high-mortality, and 64% of black patients in the study group were treated at these high-mortality centers compared to only 41% of white patients.

Haider says detailed attention was given to making risk adjustments for the trauma patients cited by the study. "We risk adjust patients on age, the injury severity score, their physiologic state when they got injured and when they got to us," he says. "Every way we cut this it makes sense because it is very sensitive stuff. Once you say it, you can't take it back so you have to be super right when you do it."

The analysis also showed that 45% of patients at high-mortality centers don't have insurance, compared to 21% at low-mortality hospitals.

"We did not study hospitals' bottom lines, so now I am speculating, but if you have a better bottom line because you have more insured patients then you are able to invest in more stuff and you are able to do a better job and keep getting better," Haider says.

"On the other hand if you are working under extreme pressure and you have to take care of a lot of patients and you are not getting paid to take care of these patients, then it is difficult to improve quality. I don't mean to give a pass to hospitals that are on the bottom of the ranking, but I totally understand why they are doing such a difficult job. I have seen myself hospitals that are working in difficult circumstances that are doing a fantastic job with what they have. If they had more resources they would be fantastic and would go right up the list."

While the findings in the study are troublesome, Haider says he takes some solace in knowing that the results did not show any treatment bias on the part of trauma teams.

"We talk about healthcare disparity all the time but the fact is that no matter your skin color, white, black, or Hispanic, they ended up with the same results based on what hospital you went to," Haider says. "If you went to a low-performing hospital and you were white, you [would] have the same results as a black guy at that hospital."

"Similarly," he says, "if you went to a high performing hospital whether you were black or white you all did good. That was very heartwarming to see and a very positive finding for the study because a lot of disparity studies keep on showing that minority patients are doing worse, but this one shows that trauma centers do a great job if they are able to do a good job they do it no matter who you are. But obviously not all trauma centers can do a good job."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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