• José F Figueroa, Laura G Burke, Kathryn E Horneffer, Jie Zheng, John OravEEE. John Orav is an associate professor of biostatistics in the Department of Medicine, Brigham and Women's Hospital., and Ashish K Jha.
• José F. Figueroa (jfigueroa@hsph.harvard.edu) is an assistant professor of health policy and management in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, and an associate physician and assistant professor of medicine in the Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, both in Boston, Massachusetts.
• Health Aff (Millwood). 2020 Jun 1; 39 (6): 1065-1071.

AbstractRacial disparities in hospitalization rates for ambulatory care-sensitive conditions are concerning and may signal differential access to high-quality ambulatory care. Whether racial disparities are improving as a result of better ambulatory care versus artificially narrowing because of increased use of observation status is unclear. Using Medicare data for 2011-15, we sought to determine whether black-white disparities in avoidable hospitalizations were improving and evaluated the degree to which changes in observations for ambulatory care-sensitive conditions may be contributing to changes in these gaps. We found that while the racial gap in avoidable hospitalizations due to such conditions has decreased, that seems to be explained by a concomitant increase in the gap of avoidable observation stays. This suggests that changes from inpatient admissions to observation status seem to be driving the reduction in racial disparities in avoidable hospitalizations, rather than changes in the ambulatory setting.

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