Leapfrog Group: Health disparities persist in highly rated hospitals

Hospitals that receive high safety grades and score well on external safety measures do not provide better care to patients of color than lower-rated facilities, according to a study of more than 10 million patient records.

The research from Leapfrog Group and Urban Institute, which used 2019 discharge data from across 15 states, found that Black and Latino patients are more at risk of experiencing adverse safety events than white patients, regardless of a hospital’s Leapfrog Group ranking.

Twice a year, the Leapfrog Group releases safety grades on hospitals nationwide based on their self-reported data on safety performance and adverse events like medication errors, infections and surgery complications. The watchdog organization’s scores are considered a well-respected indicator of a hospital’s quality and safety for potential patients. 

Across all hospitals, Black and Latino patients experienced 34% higher rates of sepsis after surgery than white patients, and Black patients experienced 51% higher rates of dangerous blood clots as surgery-related complications, the research found. 

The findings point to a need for greater scrutiny on the intersection of patient safety and care inequity.

“This seems to be a symptom of structural racism across hospitals, systematically,” said Anuj Gangopadhyaya, an author of the report and senior research associate at the Urban Institute’s health policy center. “If we have the capacity to improve overall scores, we should have the capacity to reduce inequities among patient subgroups within our institutions.”

Rather than being satisfied with their performance on external quality and safety measures, hospitals need to reevaluate and update policies and programs to better address disparities in quality outcomes, Gangopadhyaya said. “As a hospital becomes ‘higher quality,’ you would expect disparities might uniformly go down across all patient groups, and that’s just not the case here,” he said. 

All patients are at a lower risk of falls, infections and pressure ulcers in “A”-graded hospitals than in “C,” “D,” or “F”-graded hospitals. However, Black and Latino patients are not as safe as white patients in higher-ranked facilities.  

The study found larger disparities between Black and white patients for rates of sepsis, hemorrhage and other adverse events related to surgery at Leapfrog’s “A” hospitals.

At “A” hospitals, the rate of perioperative hemorrhage in white patients was 2.01 cases per 1,000 at-risk discharges, compared with 2.80 cases for Black patients. Rates of perioperative pulmonary embolism or deep vein thrombosis were 2.87 cases and 4.22 cases, respectively.