To develop a tool for quantifying health disparity (Health Disparity Index, HDI) and explore hospital variation measured by this index using chest radiography (CXR) in asthma as the proof of concept.
Retrospective cohort study using the Pediatric Health Information System database including children with asthma between 5-18 years old. Inpatient and emergency department (ED) encounters from 1/1/2017 to 12/31/2018 with low or moderate severity were included. Exclusions included hospitals with <10 cases in any racial/ethnic group. The HDI measured variation in CXR utilization among children with asthma based upon race/ethnicity. The HDI was calculated as the absolute difference between maximum and minimum percentages of CXR use (range = 0 to 100) when there was statistical evidence that the percentages were different.
Data from 36 hospitals included 16,744 IP and 75,805 ED encounters. Overall, 19.7% of encounters had a CXR (34.3% for IP; 16.5% for ED). In IP encounters, 47.2% (17/36) of hospitals had a significant difference in imaging across racial/ethnic groups. Of these, the median hospital-level HDI was 19.4% (IQR: 13.5-20.1). In ED encounters, 78.8% (28/36) of hospitals had a statistically significant difference in imaging across racial/ethnic groups, with a median hospital-level HDI of 10.2% (IQR: 8.3-14.1). There was no significant association between the IP HDI and ED HDI (P = .46).
The HDI provides a practical measure of disparity. To improve equity in healthcare, metrics are needed that are intuitive, accurate, usable, and actionable. Next steps include application of this index to other conditions.

Copyright © 2021. Published by Elsevier Inc.