Factors underlying racial disparities in hospital care of congestive heart failure.

OBJECTIVE: To examine relationships between race and five aspects of hospital care. METHODS: Cross-sectional data of 373,158 discharges with heart failure in the 1995-1997 National Inpatient Sample were used to measure severity, care-seeking patterns, processes, resource consumption, and outcomes. RESULTS: Compared to White patients, African American and Hispanic patients were more likely to seek care through the emergency department (ED) but less likely to receive clinical procedures or die in the hospital. Interactions of African American race with patient co-morbidity status, admission through the ED, and receipt of intensive services were associated with lower mortality as was interaction between admission to teaching hospitals and Hispanic race. CONCLUSIONS: Lack of access to ambulatory care among minority patients and hospital care via the safety net may contribute to racial discrepancies as a result of healthier patient selection among minority groups.

A point of care clinical documentation system for hospice care providers.

This article identifies two areas of hospice care that may benefit the most from a point-of-care (POC) clinical documentation system: documentation for recertification and symptom/pain management. Applications as solutions for the hospice POC clinical documentation system need two documentation support tools: (1) knowledge-based external or internal reference data available to physicians or medical staff right at the bedside and (2) assisting medical staff in filling out electronic forms for clinical measurements by providing real-time prompts, clues, alerts, or other types of feedback, along with the common features such as pre-defined values in specific fields. Our study may encourage more software vendors to include clinical documentation support tools in their solutions.

Health and GIS: toward spatial statistical analyses.

This study examined the extent to which health studies, mostly in public health and epidemiology, used geographical information systems (GIS). We identified a wide range of tools they used-ranging from geocoding through simple buffer/overlay functions to spatial query functions. However, studies tend to rely on tools outside of GIS for spatial statistical analyses. This may reflect a lack of spatial statistical tools that are suitable for health researchers whose data are rather geographically aggregated count data than continuous data. Implementation within GIS of spatial analytical tools suitable for aggregated data over a region will increase the use of GIS beyond simple GIS operations in health studies.

Patterns of hospital-based pediatric care across diverse ethnicities: the case of pneumonia.

Few studies have evaluated racial disparities with respect to process and outcome measures for pneumonia. We evaluated disparities with respect to process measures in addition to clinical and financial outcome measures in a pediatric population from 0 to 18 years of age. The data showed that minority populations were admitted at younger ages and were more likely to be admitted through the emergency department than their white counterparts. Substantial variation exists with respect to patterns of care and outcomes for pneumonia in pediatric patients among different ethnic/racial groups. Differences in outcomes may be associated with several factors, including variations in quality of care across different hospital settings, characteristics related to disease severity among different ethnic groups, and other unidentified factors. Further research is needed to clearly define how differences with respect to quality of care, access to care, disease severity, and care-seeking behaviors contribute to differences in outcomes across different ethnic groups.