Becker's Hospital Review

19 CMO / CARE DELIVERY Leapfrog: Disparities persist at top-graded hospitals By Erica Carbajal R acial disparities in rates of adverse events persist even at the top-rated hospitals for safety, a new report from e Leapfrog Group shows. e Leapfrog Group assigns letter grades to nearly 3,000 acute care general hospitals across the U.S. every fall and spring. e safety grades are recognized for being the only hospital ratings program solely based on hospitals' ability to protect patients from preventable errors, accidents, injuries and infections. However, "little is known about the association between Hospital Safety Grades and the delivery of safe care specific to a patient's racial-ethnic background or insurance," researchers from Leapfrog and the Urban Institute said in the report published June 7. "Further, no evidence indicates whether safer overall care is associated with narrowing disparities in patient safety among patients with different racial-ethnic backgrounds or among patients with different types of insurance." us, they conducted an analysis based on 2019 hospital discharge data from 15 states, including more than 10 million patient records. ey compared the rate of 11 adverse safety events by racial and ethnic background, as well as by payer type. Overall, care was safer for all racial groups at higher-graded hospitals, but Black and Hispanic patients were still at increased risk of certain adverse safety events compared to white patients, even at "A" and "B" graded hospitals. e findings showed: • Black patients were more likely to experience surgery-related complications than white patients. ey experienced 34 percent higher rates of sepsis aer surgery; 51 percent higher rates of dangerous blood clots aer surgery; and 17 percent higher rates of respiratory failure aer surgery. • Across all hospital safety grades, Black patients faced significantly higher risks of stage 3 and 4 pressure ulcers. • Relative to white patients, Hispanic patients also experienced a higher risk of sepsis (34 percent) and respiratory failure (21 percent) aer surgery, "and these differences remain significant at higher-graded hospitals," researchers said. • Compared to those with private insurance, patients covered by Medicare or Medicaid experienced higher rates of adverse safety events. "Leapfrog Hospital Safety Grades, therefore, cannot be used to convey information on the underlying disparity in safe inpatient care," the report said. "From a policy perspective, our findings indicate that Black and Hispanic patients and, separately, patients with public insurance would benefit from better tools to help them assess the additional risk that may accompany a hospital stay," in addition to the need for hospitals to devote adequate resources and interventions to eliminate disparities. n 1 healthcare leader's plea: 'We need better connection between generations' By Mariah Taylor E ach generation views the world differently, and there are some communication gaps administrators and systems have not yet bridged with younger physicians, Doug Bruce, MD, chief clinical integration officer at Cleveland-based MetroHealth, recently told Becker's. Some new physicians are coming to the field wanting to work fewer hours; they are willing to make less money if it means having a more enjoyable life. "We have to help administrators understand that times have changed," Dr. Bruce said. "We're in a post-pandemic world, and people coming out don't think it makes sense to work until you drop or work until you retire and you're now too old to enjoy your life. Residents want to enjoy some of that now. That's part of this big reconciliation that needs to happen." Administrators tend to be from a different generation than the new physicians and clinicians entering the practice. Anytime someone does something different, a common response is to reject that practice, "but that's just not a good response," Dr. Bruce said. He added that right now, administrators and clinicians might be having the wrong conversation. "My plea is for people just leaving residency to have these conversations with administrators. Educate them about the why, because the assumption is, 'You don't want to work that hard,' which is not the issue. Help them understand that 'I'm happy to work hard when I'm here, I just don't want to be here all the time.'" For Dr. Bruce, it is important for physicians and administrators to work together to find a happy medium. "We need these physicians as they're coming out and the nurse practitioners and the physician assistants and nurses. Everybody's looking to operate differently within the medical care environment. We need to be flexible and unfortunately that makes things more complicated. It's the reality. We really need to see a better connection between the generations." n

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