Measurable differences in patient safety across race, ethnicities and insurance coverage persist even among hospitals rated at the top of their class, according to a new analysis of Leapfrog Hospital Safety Grades published Wednesday.
The report, conducted with funding from AARP and put together by the watchdog organization and Urban Institute, broadly found that patients should expect safer care at hospitals that received the Leapfrog Group’s highest rating compared to those given a “C,” “D” or “F” “irrespective of their racial and ethnic backgrounds.
Specifically, six out of the 11 patient safety indicators (PSIs) measured in the study showed significantly lower rates of safety events at “A” grade hospitals than the three lowest letter grades, according to the report.
When comparing rates among patients of specific backgrounds, Black patients had significantly higher safety event rates than white patients for five of the 11 PSIs (primarily surgery-related indicators) and lower safety event rates for two. Compared to white patients, Hispanic patients had significantly higher adverse safety event rates for two of the 11 PSIs and significantly lower rates for four PSIs.
However, comparing the PSIs for which specific patient races and ethnicities differed across the graded hospitals showed “little to no pattern” regarding the magnitude of those rate differences, Leapfrog and Urban found.
“The hospital’s Safety Grade does not ensure that any disparity in the quality of care delivered to different patient populations will be minimized,” they wrote in the report. “In other words, these findings suggest that the hospitals most adept at achieving safe care overall are no better at identifying and narrowing inequities in the delivery of that care.”
The finding was similar for analyses related to patients’ source of coverage. Medicare patients and Medicaid patients were found to have significantly higher adverse safety event rates compared to privately insured patients for 10 and eight of the PSIs, respectively, yet the groups did not find a substantial pattern to how those differences would change based on a hospital’s letter grade, they wrote.
“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,” Anuj Gangopadhyaya, Ph.D., senior research associate in the Health Policy Center at the Urban Institute, said in a release. “Hospitals should recognize these disparities and ensure resources are devoted to reducing adverse safety events among patient groups at the highest risk.”
The group’s analysis was based on 2019 hospital discharge data from 15 states obtained from the Agency for Healthcare Research and Quality’s patient records database, representing a total of more than 10 million adult patient records. Short-term acute care hospitals that received a Hospital Safety Grade from Leapfrog in spring 2022 were included.
“We must honestly acknowledge the persistent racial and ethnic disparities, but we can't stop there,” Missy Danforth, vice president of healthcare ratings at The Leapfrog Group, said in a release. “Achieving safe care for all patients requires a focused commitment to transparency, better data collection and targeted interventions.”