Nationwide disparities in the quality of hospital care between whites and minorities have deceased for those with acute myocardial infarction, heart failure and pneumonia, a University of Pittsburgh study has found, but an accompanying Harvard-based study published last week in the New England Journal of Medicine found that differences persist in the control of blood pressure, cholesterol and glucose among the various racial and ethnic groups of Medicare enrollees, which might contribute to persistent disparities in health outcomes in most regions of the country.

The Pitt study, Quality and Equity of Care in U.S. Hospitals, published last week online, showed progress from 2005 to 2010 with increased racial and ethnic equity for hospitalized African-American and Hispanic adults, as compared with white patients.

Reductions in disparities between race and ethnic groups resulted from more equitable care for white patients and minority patients treated in the same hospital, and greater performance improvements among hospitals that disproportionately serve minority patients, states the study, led by Michael J. Fine, a professor of medicine at the Pitt School of Medicine. The study also involved researchers from Brown University, the Centers for Medicare and Medicaid Services and various veteran health centers.

Previous studies found elderly African-American and Hispanic patients to be concentrated in a relatively small number of hospitals with poor performance ratings. That raised concern that pay-for-performance plans, which reward hospitals for good health outcomes and publicly reported results, penalize hospitals that disproportionately serve minority patients and reward hospitals that avoid minority patients.

Equity is a key dimension of health care quality, the Pitt study states. Therefore, efforts to gauge progress in quality of care must include explicit considerations of whether gains have also occurred in health care equity.

The study focused on 17 procedures to improve outcomes, including providing aspirin to heart-attack patients and influenza vaccinations to pneumonia patients, and clearing blood clots from the arteries of heart-attack patients within 90 minutes of arrival. In 2005, nine metrics had gaps between whites and minorities greater than 5 percent. By 2010, all gaps had narrowed significantly, the study shows.

Our study provides support for the notion that efforts to improve the overall quality of care may also reduce racial and ethnic disparities, the study states. Disparities reflect care that is not rendered according to patients clinical needs or their informed preferences.

Marshall Chin, a University of Chicago physician and health care ethicist whose editorial on the topic appeared in the same journal edition, said the Pitt study was well done but limited by not addressing disparities in patient outcomes.

He said that eliminating disparities requires addressing the realities of the persons life, including access to healthy food, medications and safe places to exercise. Disparities in care should motivate efforts to eliminate them, with a focus on prevention and underlying cultural, social and economic factors affecting each patient.

Improving the quality of care helps, but we need patient-centered care that looks at each person as an individual and tailors care to that person, Dr. Chin said. One-size-fits-all doesnt work.

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Health care services gap narrows between whites and African-Americans