CLINICAL RESEARCH: HEART FAILURE
Impact of race on health care utilization and outcomes in veterans with congestive heart failure
Anita Deswal, MD, MPH* ,*,
Nancy J. Petersen, PhD*,
Julianne Souchek, PhD*,
Carol M. Ashton, MD, MPH* and
Nelda P. Wray, MD, MPH
* Houston Center for Quality of Care and Utilization Studies, Houston, Texas, USA
Winters Center for Heart Failure Research, Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
Office of Research and Development, Department of Veterans Affairs, Washington, DC., USA
Manuscript received June 9, 2003;
revised manuscript received September 2, 2003,
accepted October 27, 2003.
* Reprint requests and correspondence: Dr. Anita Deswal, VA Medical Center (152), 2002 Holcombe Boulevard, Houston, Texas 77030, USA.
adeswal{at}bcm.tmc.edu
OBJECTIVES: The objectives of this study were to determine racial differences in mortality in a national cohort of patients hospitalized with congestive heart failure (CHF) within a financially "equal-access" healthcare system, the Veterans Health Administration (VA), and to examine racial differences in patterns of healthcare utilization following hospitalization.
BACKGROUND: To explain the observed paradox of increased readmissions and lower mortality in black patients hospitalized with CHF, it has been postulated that black patients may have reduced access to outpatient care, resulting in a higher number of hospital admissions for lesser disease severity.
METHODS: In a retrospective study of 4,901 black and 17,093 white veterans hospitalized with CHF in 153 VA hospitals, we evaluated mortality at 30 days and 2 years, and healthcare utilization in the year following discharge.
RESULTS: The risk-adjusted odds ratios (OR) for 30-day and 2-year mortality in black versus white patients were 0.70 (95% confidence interval [CI] 0.60 to 0.82) and 0.84 (95% CI 0.78 to 0.91), respectively. In the year following discharge, blacks had the same rate of readmissions as whites. Blacks had a lower rate of medical outpatient clinic visits and a higher rate of urgent care/emergency room visits than whites, although these differences were small.
CONCLUSIONS: In a system where there is equal access to healthcare, the racial gap in patterns of healthcare utilization is small. The observation of better survival in black patients after a CHF hospitalization is not readily explained by differences in healthcare utilization.
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Abbreviations and Acronyms
| | CHF | = congestive heart failure | | DRG | = diagnosis related group | | ER | = emergency room | | HF | = heart failure | | ICD-9-CM | = International Classification of Diseases-Ninth Revision-Clinical Modification | | PTF | = patient treatment files | | VA | = Veterans Health Administration |
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