Racial disparities in access to appropriate, high quality health care have been extensively documented and are believed to contribute to substantially lower life expectancy in the African-American compared to the white population in the United States. The third leading contributor to black-white disparities in mortality as measured in potential life-years lost is death due to injury. However, the influence of race on access to care for injury has received only limited scrutiny. The goal of the proposed research is to understand the influence of race on quality of care for injured patients, as reflected in structure, process and outcomes of hospital care for injuries. Nationally representative hospital claims data from the Healthcare Cost and Utilization Project, hospital characteristics from the American Hospital Association Annual Survey and community characteristics from the Area Resources File will be analyzed to address three specific Aims:
Specific Aim 1 : To determine whether there are differences in the structural aspects of healthcare delivery for racial/ethnic minority patients versus white injured patients, as reflected by characteristics of the hospitals to which they are admitted and the availability of trauma resources in their communities.
Specific Aim 2 : To identify whether there are differences in processes of care delivered to racial/ethnic minority patients during hospitalization after injury, particularly among subsets of injured patients for whom specific procedures are expected to be delivered.
Specific Aim 3 : To examine whether differences by race in hospital characteristics and processes of care are predictive of previously identified disparities in outcome after injury. The proposed research represents an important first step in addressing the contribution of injuries to racial disparities in health and mortality. Previous research has indicated the presence of a racial disparity in mortality after injury, but has not addressed several questions which must be ansared before interventions can be designed to close the gap. These questions, addressed by the specific Aims above, begin to identify where the healthcare system may be failing injured racial/ethnic minority patients. ? ? ? ?
