TY - JOUR
T1 - Impact of race on health care utilization and outcomes in veterans with congestive heart failure
AU - Deswal, Anita
AU - Petersen, Nancy J.
AU - Souchek, Julianne
AU - Ashton, Carol M.
AU - Wray, Nelda
N1 - Funding Information:
This study was supported in part by VA Health Services Research and Development grants # CHF-98-000-1 (VA CHF QUERI) and IIR 02-082-1. Dr. Deswal is recipient of a VA Cooperative Studies Program Clinical Research Career Development Award (CRCD #712). The views expressed herein are those of the authors and do not necessarily represent those of the Department of Veterans Affairs.
PY - 2004/3/3
Y1 - 2004/3/3
N2 - 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.
AB - 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.
KW - CHF
KW - Congestive heart failure
KW - Diagnosis related group
KW - DRG
KW - Emergency room
KW - ER
KW - Heart failure
KW - HF
KW - ICD-9-CM
KW - International Classification of Diseases-Ninth Revision-Clinical Modification
KW - Patient treatment files
KW - PTF
KW - VA
KW - Veterans Health Administration
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U2 - 10.1016/j.jacc.2003.10.033
DO - 10.1016/j.jacc.2003.10.033
M3 - Article
C2 - 14998616
AN - SCOPUS:1542271692
SN - 0735-1097
VL - 43
SP - 778
EP - 784
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 5
ER -