This brief investigates rates of adverse patient safety events across hospitals in Washington, DC, from 2017 to 2020. The analysis examines rates of adverse safety events overall and differences across three racial and ethnic groups: white non-Hispanic, Black non-Hispanic, and Hispanic patients.

Why This Matters

Racial and ethnic disparities in the delivery of safe hospital care are long-standing. Examining unequal access to safe hospital care within a city presents opportunities for local policymakers and stakeholders to assess how to best redirect limited resources to improve equitable hospital care citywide.

Within DC, racial residential segregation functions as a structural determinant of health, as it produces racial and ethnic differences in access to safe hospitals, yielding disparate patient safety outcomes. Therefore, reducing racial disparities in patient safety within DC requires increased funding and support for all hospitals to emulate the patient care practices of better-resourced, safer hospitals.

What We Found

• Across DC hospitals, Black patients experience a 37.3 percent higher incidence of adverse safety events relative to white patients, but there were no significant differences between Hispanic and white patients.
• There are no significant differences in rates of adverse safety events within DC hospitals between Black and white patients. In other words, Black and white patients treated at the same DC hospital could expect similar risks of adverse safety events.
• Instead, Black-white disparities in patient safety in DC appear to be driven by unequal access to the safest hospitals. About 37.7 percent of white patients in DC accessed the hospital with the best safety record, compared with only 3.7 percent and 8.4 percent of Black and Hispanic patients, respectively.
• About two-thirds (66.9 percent) of white patients accessed the three hospitals with the best safety records in DC, while less than one-third (29.9 percent) of Black patients accessed the same three hospitals.

How We Did It

This analysis draws on hospital discharge data from the state inpatient databases processed by the Agency for Healthcare Research and Quality for its Healthcare Cost and Utilization Project and examines DC discharge records from 2017 to 2020. Adverse safety events are measured using AHRQ patient safety indicators, which are clinically validated measures of injuries or illnesses patients acquire unrelated to the primary diagnoses that initiated their hospital admission. To assess variation in access to safe hospitals within DC, this brief analyzes differences in patient safety on three levels: zip-code level discharges, patient-level discharges, and hospital-level discharges.