News in brief - Dec. 5, 2011

Disparities seen in diverticulitis care between blacks and whites

Older blacks with diverticulitis are more likely to be rushed to the operating room for emergency surgery and more likely to die in the hospital than whites of similar age who need the same surgery, a new study says.

All patients in the study were covered by Medicare, and the analysis controlled for differences in reported underlying medical comorbidity. Thus, said the study in the November Archives of Surgery, "this finding contradicts the hypothesis that black race serves merely as a surrogate for either reduced likelihood of having health insurance coverage or an increased likelihood of carrying substantial medical comorbidity in blacks" (archsurg.ama-assn.org/cgi/content/abstract/146/11/1272/).

Researchers examined Medicare data on 52,220 patients 65 and older who underwent diverticulitis surgery between 2004 and 2007, including 49,937 whites and 2,283 blacks. They found that blacks had a 26% greater risk of having emergency diverticulitis surgery than whites.

Black diverticulitis surgery patients had a 28% greater risk of in-hospital mortality. With an average hospital stay of 15.2 days, blacks also tended to remain in the hospital 3.8 days longer than whites and accumulate an average of $27,521 more in hospital bills.

The study did not explain why there were differences in care between races and called for more research to find the answer. "The underlying mechanisms that lead to higher rates of emergency vs. elective admission, greater risk of in-hospital mortality, and substantially greater hospital expenses for blacks need to be elucidated so that interventions can be developed to eliminate the premature mortality and greater costs experienced by blacks," the study said.

The study noted that diverticulitis is responsible for 300,000 annual hospital admissions and direct health care costs of $2.4 billion a year.

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HHS offers conditional public access to data bank records

The Dept. of Health and Human Services' Health Resources and Services Administration in November restored public access to deidentified National Practitioner Data Bank records of adverse actions against physicians such as medical liability payments, medical board disciplinary actions and peer review sanctions. But that access will come with the restriction that reporters and others must agree not to use the information to identify individual physicians, according to a notice posted Nov. 9 by HRSA Administrator Mary K. Wakefield, PhD, RN.

The public-use file was taken down Sept. 1 after HRSA learned that it had been used by a reporter, in combination with court records, to identify actions reported to the data bank about a doctor in Kansas. Consumer-advocacy and journalism groups protested the move and said the new conditional-access rules veered close to prior restraint on freedom of the press. Consumers Union said the public should have unrestricted access to data bank records, including the names of physicians with a history of harming patients.

The American Medical Association, however, took a different position. Posting the public-use file can mislead the public and may be illegal, AMA Executive Vice President and CEO James L. Madara, MD, wrote in a Sept. 23 letter to Wakefield.

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