Quality of hospital care for Māori patients in New Zealand: retrospective cross-sectional assessment

Abstract

Background: New Zealand has a substantial indigenous minority--the Māori--that has considerably worse health status than the majority population. We aimed to assess possible disparities in quality of hospital care for Māori with data on preventable adverse events as an indicator of suboptimum treatment.

Methods: We undertook a nationally representative cross-sectional survey of admissions to general public hospitals with more than 100 beds providing acute care. A sample of 6579 patients admitted in 1998 to 13 hospitals was selected by stratified systematic list sample. We did a two-stage retrospective assessment of records by structured implicit review. Outcome measures were occurrence, effect, and preventability of adverse events.

Findings: Māori accounted for just greater than 15% of admissions and were on average younger, were more likely to be from from deprived areas, had a different case mix, and were in hospital for a shorter stay compared with patients of non-Māori/non-Pacific origin. Overall, after age standardisation, 14% of admissions for Māori were associated with an adverse event, compared with 11% for non-Māori/non-Pacific patients (p=0.01 for difference between groups). For preventable, in-hospital events, this disparity persisted after controlling for age, other sociodemographic factors, and case mix (adjusted odds ratio 1.47; p=0.05). Analysis of potential causal factors showed no markedly or consistently different pattern between the groups.

Interpretation: Despite a predominantly publicly funded hospital system, our findings suggest that hospital care received by Māori is marginally poorer than that received by New Zealand citizens of non-Māori/non-Pacific origin. Although no cause specific to Māori was evident, various policy and system issues can be addressed.