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Hispanic children diagnosed with brain tumors get 
high-quality treatment at hospitals that 
specialize in neurosurgery far less often than 
other children with the same condition, 
potentially compromising their immediate 
prognosis and long-term survival, according to 
research from Johns Hopkins published in OctoberÂ’s Pediatrics.

More than a decade after the Institute of 
MedicineÂ’s landmark report Crossing the Quality 
Chasm, the Johns Hopkins investigators say their 
findings detect persistent gaps in access to 
specialized care among certain patients, raising 
questions about how far across the chasm we have actually come.

“What was shocking to us was the finding that, 
despite the push over the last decade to equalize 
access to high-quality care, gaps are still 
there, particularly among Hispanics, and, if 
anything, they may be getting even worse,” said 
lead investigator Raj Mukherjee, M.D., M.P.H., a 
postdoctoral fellow in the Department of Neurosurgery at Johns Hopkins.

Research has shown that patients treated at 
specialty hospitals that admit a high volume of 
patients with similar conditions fare better in 
the long and short term, investigators say. For 
example, studies show that patients undergoing 
brain surgeries in hospitals that perform the 
fewest neurosurgeries have up to 16 times the 
mortality rate of patients treated in hospitals performing the highest number.

“Given that brain tumors are the most common 
solid tumors in children, lack of access to 
specialized care simply means that thousands of 
pediatric patients are getting less-than-optimal 
treatment, putting them at risk for relapse and a 
host of neurological complications,” says 
pediatric neurosurgeon George Jallo, M.D., 
co-author of the study and director of 
neurosurgery at the Johns Hopkins ChildrenÂ’s Center.

The Johns Hopkins study, which looked at 4,421 
children with brain tumors over the span of 18 
years, found that access was worst among 
Hispanics, as well as among those of lower 
socio-economic status and those living in areas 
with higher immigrant population and with few 
neurosurgeons. Insurance did not play a role in 
where a patient was treated, the researchers 
found. The Johns Hopkins team linked two 
databases -- one detailing hospital and patient 
information and another one with demographic and 
environmental information -- elucidating in a 
novel way the impact of such factors as ethnicity 
and proportion of foreign-born people in the county of residence.

Overall, only 37 percent of the patients in the 
study who should have been treated at a 
high-volume hospital had surgeries in such 
institutions. Hispanics consistently fared worse 
than the others: Even when adjusting for factors 
that may affect access to care, such as 
socioeconomic status and health insurance, 
Hispanic children still got specialized care at 
one-third the rate of other children, the Johns Hopkins team found.

“If youÂ’re a Hispanic child diagnosed with a 
brain tumor, youÂ’re far less likely to get the 
best possible treatment, and this is concerning 
in and of itself, but thereÂ’s another looming 
threat emerging from our findings,” said senior 
investigator Alfredo Quiñones-Hinojosa, M.D., 
associate professor of neurosurgery and oncology 
at Johns Hopkins. “Hispanics will make up 25 
percent of this countryÂ’s population by the year 
2050, so unless we do something about this, it 
looks like in the next few decades, a quarter of 
our population may end up getting substandard care.”

“Our findings are yet another reminder that we 
are at a unique crossroad in history as we try to 
restructure our healthcare system, and we have 
been given a chance to reduce, perhaps even 
eliminate, these inequalities once and for all,” Quiñones adds.

Researchers say that pinpointing the exact 
factors that determine who gets care and where 
they get it requires carefully designed studies 
that examine individual patient decision-making, 
as well as systemic factors, such as insurance 
and possible institutional bias in patient selection.

The research was funded in part by the Howard 
Hughes Medical Institute, the ChildrenÂ’s Cancer 
Foundation and Johns Hopkins Center for Innovative Medicine.

Co-investigators in the study include Thomas 
Kosztowski, B.S.; Hasan Zaidi, B.S.; Benjamin 
Carson, M.D.; and David Chang, Ph.D., M.P.H., M.B.A.

Related on the Web:

Alfredo Quiñones-Hinojosa, 

George Jallo: 

Raj Mukherjee:

The Alfredo Story (Hopkins Medicine):

The New York Times on Quinones:

See Dr. Jallo discussing a patient with a rare 

Dr. Quinones on neuroscience- Video

Johns Hopkins ChildrenÂ’s Center:



Johns Hopkins Children's Center
Media contact: Ekaterina Pesheva
October 8, 2009

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