• Paul L Hebert, Elizabeth A Howell, Edwin S Wong, Susan E Hernandez, Seppo T Rinne, Christine A Sulc, Emily L Neely, and Chuan-Fen Liu.
• VA HSR&D Center of Innovation for Patient Centered and Value Driven Health Care, VA Puget Sound Health Care System, Seattle, WA.
• Health Serv Res. 2017 Apr 1; 52 (2): 826-848.

ObjectiveTo compare two approaches to measuring racial/ethnic disparities in the use of high-quality hospitals.Data SourcesSimulated data.Study DesignThrough simulations, we compared the "minority-serving" approach of assessing differences in risk-adjusted outcomes at minority-serving and non-minority-serving hospitals with a "fixed-effect" approach that estimated the reduction in adverse outcomes if the distribution of minority and white patients across hospitals was the same. We evaluated each method's ability to detect and measure a disparity in outcomes caused by minority patients receiving care at poor-quality hospitals, which we label a "between-hospital" disparity, and to reject it when the disparity in outcomes was caused by factors other than hospital quality.Principal FindingsThe minority-serving and fixed-effect approaches correctly identified between-hospital disparities in quality when they existed and rejected them when racial differences in outcomes were caused by other disparities; however, the fixed-effect approach has many advantages. It does not require an ad hoc definition of a minority-serving hospital, and it estimated the magnitude of the disparity accurately, while the minority-serving approach underestimated the disparity by 35-46 percent.ConclusionsResearchers should consider using the fixed-effect approach for measuring disparities in use of high-quality hospital care by vulnerable populations.© Health Research and Educational Trust.

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