Best Practices of
High Quality
Minority Serving
Hospitals
Darrell J. Gaskin, Ph.D
Thomas A LaVeist, PhD
Disparities in Hospital Quality

Darrell J. Gaskin, PhD

Christine M. Spencer, ScD

Patrick Richard, PhD
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Gerard F. Anderson, PhD
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Neil R. Powe, MD, MPH, MBA
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Thomas A. LaVeist, PhD
Acknowledgements
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National Advisory Committee
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Ronald J. Anderson, MD
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Karen Scott Collins, MD, MPH
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Associate Research Professor, Dept of Health Policy, GWU
Director, Speaking Together: National Language Services Network
Mark Smith, MD, MBA
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President and CEO of the Greater Detroit Area Health Council.
Marsha Regenstein, PhD
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Deputy Chief Medical Officer, Health Care Quality and Clinical Services,
New York City Health and Hospitals Corporation
Vernice Anthony Davis, MPH
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President and CEO of Parkland Health and Hospital System
President and CEO of the California Healthcare Foundation.
This project is supported by a grant from the Commonwealth
Fund
Research Objective
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This study identified best practices of high
quality minority serving hospitals (HQMS).
Specifically, we discuss the importance of
leadership identified how they achieve high
quality care to their minority patients.
Why Study HQMS Hospitals?
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Disparities in hospital care has been linked to
minority patients’ use of low quality hospitals.
Best practices of HQMS hospitals may help
low performing hospitals that serve high
proportions of minority patients.
Challenges Faced by
Minority Serving Hospitals
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Increased Patient Severity
Payer Mix
Lack of Primary Care
Diversity
Lack of Social Support and Community Based
Resources.
Study Design
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Using SID data from 13 states, we identified 166
minority serving hospitals.
Minority serving hospitals - 50 % of their discharges
were African American, Hispanic or Asian patients.
High quality hospitals – top quartile in composite
quality scores for the AHRQ IQI and PSI.
31 HQMS hospitals based on the IQI and 47 HQMS
hospitals based on their PSI.
We selected 6 HQMS hospitals. We conducted a site
visit at each HQMS hospital.
Diverse Sites
 Racial
Ethnic Mix
 Geographically
 Safety Net and Teaching Status
 Ownership
Site Visits
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60-90 minutes interviews with CEO, CFO, medical
director, quality improvement officer and head of
nursing.
10 – 12 questions covering five domains: quality
improvement initiatives, cultural competency,
workforce diversity, the adoption of IT and other new
technologies, and financial issues.
Tour of Facilities
HQMS Hospitals
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Stable Leadership Who Are Committed to
Excellence
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Integral Part of their Communities
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Zero Tolerance for Disparities in Care
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Cultivate Friends in High Places
HMQS Hospitals
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Knowledgeable about their Communities’ Needs
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Cognizance of the Big Picture
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Effective Use of Information Technology
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Effectively Manage Limited Resources
Conclusions and Implications
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HQMS hospitals have developed effective
strategies to deliver high quality care to their
patients despite fiscal pressure and the unique
needs minority patients.
Best practices of HQMS hospitals can be
replicated in other hospitals, particular those
serving minorities.
Contact Information
Darrell J. Gaskin, PhD
Associate Professor of Health Economics
African American Studies Department
College of Behavioral and Social Sciences
University of Maryland
2169 LeFrak Hall
College Park, Maryland 20742
301-405-1162 (phone)
301-314-9932 (fax)
dgaskin@aasp.umd.edu
Sample Site Visits Questions
1.
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Can you identify/describe any specific Quality Improvement
Efforts/Programs that have been implemented by your
hospital that have been particularly successful? Have these
efforts/programs specifically addressed the needs of minority
patients? If so, how?
Does the hospital have a strategy to recruit, retain and
promote qualified, diverse and culturally competent
administrative, clinical and support staff?
Has the hospital implemented cultural competency training
programs? If so, who is required to participate in these
programs? If not, how does the hospital ensure that care is
delivered in a culturally competent manner?
Sample Site Visit Questions
1.
2.
3.
Does the hospital provide all patients with limited
English proficiency access to bilingual staff or
interpretation services?
Does the hospital collect and analyze data on its
patients by different racial/ethnic minority groups?
What do you think are the major
challenges/impediments that hinder the hospitals’
ability to provide quality care to its minority patients?
Data
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We used state inpatient discharge data from 13
thirteen states.
2001-2003 SID data from AZ, CO, FL, IA, MA,
MD, MI, NC, NJ, NY, TX and WI
2000-2002 SID data from PA
Inpatient Quality Indicators Used to
Create IQI Composite Score
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Four inpatient procedure mortality rates
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Abdominal aortic aneurysm repair
CABG
Craniotomy
Hip Replacement
Six inpatient condition mortality rates
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AMI
CHF
Stroke
GI hemorrhage
Hip Fracture
Pneumonia
Patient Safety Indicators Used to
Create PSI Composite Score
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Complications of Anesthesia
(PSI 1)
Decubitus Ulcer (PSI 3)
Failure to Rescue (PSI 4)
Iatrogenic pneumothorax
(PSI 6)
Infection due to Medical
Care (PSI 7)
Postop Hip Fracture (PSI 8 )
Postop Hemorrhage or
Hematoma (PSI 9)
Postop Physio and Metabolic
Derangement (PSI 10)
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Postop Respiratory Failure
(PSI 11)
Postop PE or DVT (PSI 12)
Postop Sepsis (PSI 13)
Postop Wound Dehiscence
(PSI 14)
Accidental Puncture (PSI 15)
Birth Trauma (PSI 17)
OB Trauma vaginal with
instr. (PSI 18)
OB Trauma vaginal without
instr. (PSI 19)