Performance of racial and ethnic minority-serving hospitals on delivery-related indicators

Am J Obstet Gynecol. 2014 Dec;211(6):647.e1-16. doi: 10.1016/j.ajog.2014.06.006. Epub 2014 Jun 5.

Abstract

Objective: We sought to explore how racial/ethnic minority-serving hospitals perform on 15 delivery-related indicators, and examine whether indicators vary by race/ethnicity within the same type of hospitals.

Study design: We used 2008 through 2011 linked State Inpatient Database and American Hospital Association data from 7 states, and designated hospitals with >50% of deliveries to non-Hispanic white, non-Hispanic black, and Hispanic women as white-, black-, and Hispanic-serving, respectively. We calculated indicator rates per 1000 deliveries by hospital type and, separately, for non-Hispanic white, non-Hispanic black, and Hispanic women within each hospital type. We fitted multivariate Poisson regression models to examine associations between delivery-related indicators and patient and hospital characteristics by hospital type.

Results: White-serving hospitals offer obstetric care to an older and wealthier population than black- or Hispanic-serving hospitals. Rates of the most prevalent indicators examined (complicated vaginal delivery, complicated cesarean delivery, obstetric trauma) were lowest in Hispanic-serving hospitals. Generally, indicator rates were similar in Hispanic- and white-serving hospitals. Black-serving hospitals performed worse than other hospitals on 12 of 15 indicators. Indicator rates varied greatly by race/ethnicity in white- and Hispanic-serving hospitals, with non-Hispanic blacks having 1.19-3.27 and 1.15-2.68 times higher rates than non-Hispanic whites, respectively, for 11 of 15 indicators. Conversely, there were few indicator rate differences by race/ethnicity in black-serving hospitals, suggesting an overall lower performance of these hospitals compared to white- and Hispanic-serving hospitals.

Conclusion: We found considerable differences in delivery-related indicators by hospital type and patients' race/ethnicity. Obstetric care quality measures are needed to track racial/ethnic disparities at the facility and population levels.

Keywords: United States; delivery; ethnicity; quality of care; race.

MeSH terms

  • Adult
  • African Americans / statistics & numerical data
  • Age Distribution
  • Cesarean Section / statistics & numerical data
  • Cohort Studies
  • Delivery, Obstetric / statistics & numerical data*
  • Ethnic Groups / statistics & numerical data*
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Hispanic Americans / statistics & numerical data
  • Hospital Mortality
  • Hospitals / classification
  • Hospitals / standards
  • Hospitals / statistics & numerical data*
  • Humans
  • Hysterectomy / statistics & numerical data
  • Income / statistics & numerical data*
  • Minority Groups / statistics & numerical data*
  • Multivariate Analysis
  • Peripartum Period
  • Poisson Distribution
  • Postoperative Complications / epidemiology*
  • Pregnancy
  • Puerperal Infection / epidemiology*
  • Quality Indicators, Health Care / statistics & numerical data*
  • Regression Analysis
  • Retrospective Studies
  • United States / epidemiology
  • Uterine Rupture / epidemiology
  • Young Adult