Send to

Choose Destination
N Engl J Med. 2014 Dec 11;371(24):2298-308. doi: 10.1056/NEJMsa1405003.

Quality and equity of care in U.S. hospitals.

Author information

From the Providence Veterans Affairs (VA) Medical Center and the Department of Health Services, Policy, and Practice, Brown University School of Public Health - both in Providence, RI (A.N.T.); Oklahoma Foundation for Medical Quality (W.N., A.M.) and the Colleges of Medicine and Public Health, University of Oklahoma Health Sciences Center (D.W.B.) - both in Oklahoma City; VA Pittsburgh Healthcare System, VA Center for Health Equity Research and Promotion (L.R.M.H., M.K.M., M.J.F.), Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine (L.R.M.H, J.S.L., M.J.F.), and the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (M.K.M) - all in Pittsburgh; and the Centers for Medicare and Medicaid Services, Baltimore (K.B., F.L.).



Nearly every U.S. hospital publicly reports its performance on quality measures for patients who are hospitalized for acute myocardial infarction, heart failure, or pneumonia. Because performance rates are not reported according to race or ethnic group, it is unclear whether improvements in equity of care have accompanied aggregate improvements in health care quality over time.


We assessed performance rates for quality measures covering three conditions (six measures for acute myocardial infarction, four for heart failure, and seven for pneumonia). These rates, adjusted for patient- and hospital-level covariates, were compared among non-Hispanic white, non-Hispanic black, and Hispanic patients who received care between 2005 and 2010 in acute care hospitals throughout the United States.


Adjusted performance rates for the 17 quality measures improved by 3.4 to 57.6 percentage points between 2005 and 2010 for white, black, and Hispanic adults (P<0.001 for all comparisons). In 2005, as compared with adjusted performance rates for white patients, adjusted performance rates were more than 5 percentage points lower for black patients on 3 measures (range of differences, 12.3 to 14.2) and for Hispanic patients on 6 measures (5.6 to 14.5). Gaps decreased significantly on all 9 of these measures between 2005 and 2010, with adjusted changes for differences between white patients and black patients ranging from -8.5 to -11.8 percentage points and from -6.2 to -15.1 percentage points for differences between white patients and Hispanic patients. Decreasing differences according to race or ethnic group were attributable to more equitable care for white patients and minority patients treated in the same hospital, as well as to greater performance improvements among hospitals that disproportionately serve minority patients.


Improved performance on quality measures for white, black, and Hispanic adults hospitalized for acute myocardial infarction, heart failure, or pneumonia was accompanied by increased racial and ethnic equity in performance rates both within and among U.S. hospitals. (Funded by the Centers for Medicare and Medicaid Services and the Veterans Affairs Health Services Research and Development Career Development Program.).

Comment in

[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center