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June 12, 2002

Racial Disparities in Health Care—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(22):2942-2943. doi:10.1001/jama.287.22.2942

In Reply: Among a national sample of Medicare beneficiaries enrolled in managed care plans, we found significantly lower quality of care for blacks than whites. With the exception of breast cancer screening, these disparities in quality were not fully explained by other individual factors that were available to us or by concentration of blacks in plans that provided lower quality of care.

The Health Plan Employer Data and Information Set (HEDIS) data we used represent an important advance over analyses based on "utilization," "claims," or "administrative" data. As Drs Barnhart and Wassertheil-Smoller suggest, studies based only on claims or utilization data frequently lack important clinical details that might explain observed racial disparities. We agree that in studies of racial disparity it is important to account carefully for clinical status, and we believe the HEDIS protocol for data collection does this. For example, the quality measure of β-blocker use after myocardial infarction excludes patients with clinical contraindications to β-blocker use. While some HEDIS measures can be calculated using claims data alone, most health plans also use specified protocols to review medical records for evidence of such contraindications. Also, recent studies show unexplained racial disparities in influenza vaccination,1 cardiac revascularization,2,3 and renal transplantation4 despite controlling for detailed clinical characteristics, as well as patients' beliefs and preferences about health care.

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