OBJECTIVE:The objective of this study was to assess the quality ofoutpatientcare received by patients withcongestiveheartfailure(CHF) and whetherdifferencesin care and outcomes exist byrace/ethnicity.BACKGROUND:AppropriateoutpatientCHFmanagementcan improve patient well-being and reduce the need for costly inpatient care. Yet, little is known regardingoutpatientCHFmanagementor whetherdifferencesin this care exist byrace/ethnicity.METHODS:Using automated data sources, we identified a cohort ofinsuredpatients seen in anoutpatientsetting for CHF between September 1992 and August 1993. Medical record abstraction was used to confirm diagnosis of CHF. Patients (N = 566) were followed until September 1998.Race/ethnicitydifferencesinoutpatientmanagementand medical care utilization were assessed using generalized estimating equations.Differencesinmortalityand hospitalization for CHF, controlling for patient characteristics andoutpatientmanagement, were assessed using Cox and Andersen-Gill models, respectively.RESULTS:With the exception of beta blocker use and primary care visit frequency, fewdifferencesbyrace/ethnicityin patient characteristics and CHFmanagementwere found. However, older black patients had morehospitaluse both at baseline and during follow up. Thesedifferencespersisted after adjusting for patient characteristics and clinicalmanagement. Norace/ethnicitydifferenceswere found inmortality.CONCLUSIONS:In aninsuredpopulation, older black patients with CHF have substantially morehospitaluse than older white patients. This increased use was not explained bydifferencesin CHFoutpatientmanagement. Further research is needed to understand whyrace/ethnicitydifferencesinhospitaluse are observed among older patients with CHF.
