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To the Editor: Mr Rathore and colleagues¹ found that black Medicare patients hospitalized with heart failure had similar quality of care as white patients and also had lower 1-year mortality rates. The authors concluded that "concerns about racial differences in quality of cardiovascular care are not an issue for Medicare patients with heart failure." This conclusion seems to be an overgeneralization of the authors' analysis.

Jencks et al² reported that Medicare inpatient quality measures, which Rathore et al used, reflect standard processes of care in hospitals. These processes are typically delivered based on protocol and, thus, would be expected to be administered to all patients regardless of race or ethnicity. These indicators are useful only for the evaluation of hospital guideline adherence or other systems of care, not for disparities based on race. The authors' assertion that health care disparities do not exist for Medicare patients with congestive heart failure . . . [Full Text of this Article]

Dawn FitzGerald
Center for Healthcare Quality
Underserved Quality Improvement Organization Support Center
Memphis, Tenn

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