Report details and key findings

For the report, researchers analyzed 2019 hospital discharge data from 15 states, which was collected from an Agency for Healthcare Research and Quality database. In total, over 10 million patient records with information on a patient's age, racial and ethnic background, insurer type, and more, were included.

Twice a year, Leapfrog releases safety grades for U.S. hospitals based on self-reported data on safety performance and adverse events, such as infections, medication errors, and surgical complications. Only hospitals that received a safety grade for spring 2022 were included in the report.

According to the report, patients had a lower risk of experiencing adverse safety events at higher-graded hospitals, but Black and Hispanic patients were still at an increased risk of adverse events compared to white patients regardless of a hospital's safety grade.

Compared to white patients, Black patients had 31% higher rates of sepsis after surgery, 51% higher rates of dangerous blood clots after surgery, and 17% higher rates of respiratory failure after surgery. Black patients were also at a significantly higher risk of Stage 3 and 4 pressure ulcers.

Hispanic patients had 34% higher rates of sepsis after surgery and 21% higher rates of respiratory failure after surgery compared to white patients. 

In addition, patients covered by Medicare or Medicaid experienced higher rates of adverse safety events compared to patients with private insurance across all hospitals.

"These data suggest that the issue does not lie in the individual hospitals themselves but is a systemic issue impacting the quality of care for Black and Hispanic patients and those with public insurance plans," said Anuj Gangopadhyaya, a senior research associate in the Urban Institute's Health Policy Center.

Commentary

According to Maulik Joshi, president and CEO of Meritus Health, it's often difficult for hospitals to know how policies and systemic bias can affect care provided to patients of color since quality measures and safety measures don't account for equity.

"Unless you know you have disparities, you can't work to reduce the disparities," Joshi said. "Hospitals and others are just not there yet, in looking at all of that consistently and reliably."

To address this issue, health systems and industry stakeholders are making efforts to identify inequities in care and test potential interventions to reduce them.

For example, Meritus Health has created teams to analyze high-level safety data by race and determine why certain areas have inequities. Team leaders then test different intervention strategies, including training on unconscious bias and care practices and raising awareness of systemwide disparity data.

In addition, CMS launched a National Quality Initiative, which aims to collect and analyze health equity data, last year. The National Committee for Quality Assurance also began to stratify its Healthcare Effectiveness Data and Information Set by race and ethnicity in 2021 as a way to encourage health plans to address disparities in patient care and outcomes.

"Hospitals should recognize these disparities and ensure resources are devoted to reducing adverse safety events among patient groups at the highest risk," Gangopadhyaya said. "If we have the capacity to improve overall scores, we should have the capacity to reduce inequities among patient subgroups within our institutions," he added. (Devereaux, Modern Healthcare, 6/7; Leapfrog news release, 6/7; Gangopadhyaya et al., Leapfrog Group, accessed 6/7)

Access this cheat sheet to learn how health disparities at the point of care can have far-reaching consequences for patients, but also for health systems’ business priorities.