To a heart-attack victim, time can be the difference between life and death. While a recent study showed that minorities wait nearly nine minutes longer for treatment than white patients, the disparity is largely due to the quality of hospital at which treatment is sought, not racism.

The results of the survey conducted by the Yale School of Medicine and the School of Epidemiology and Public Health show that average door-to-drug times — the time between arrival at the emergency department and administration of drugs to unclog arteries leading to the heart — were longer for African-American patients than for white patients. These patients waited an average of 41.1 minutes, while Hispanic patients waited 36.1 minutes and Asian-Pacific Islander patients waited 37.4 minutes. However, the average wait time for white patients was 33.8 minutes, still longer than the American Heart Association’s recommended allowable time of 30 minutes.

“I think that most of the literature in this field over the last couple of years has demonstrated significant racial disparities in health care in this country,” said Elizabeth Bradley EPH ’96, lead author of the study. “We wanted to find the reasons for these differences in minority health care.”

The differences found were attributed mainly to socioeconomic disparities, rather than to discriminatory facets.

“What we discovered was that African-American patients, along with other minority patients, were much more likely to seek treatment at a hospital that is of poorer quality,” said senior author of the study and cardiologist Harlan M. Krumholz ’80.

Bradley agreed, saying that much of the problem lies in the hospital itself, not in whether a white patient is treated before a minority patient. According to the study, approximately 70 percent of the disparity in health care is attributed to the quality of the hospital itself and how it treats any patient, regardless of ethnicity.

This study, published in the Oct. 6 issue of the Journal of the American Medical Association, is the culmination of about one and a half years of researching a random sample of hospitals nationwide. The participating hospitals voluntarily submitted data on all cardiac-arrest patients to the National Registry of Myocardial Infarction.

For a patient in cardiac arrest, a significant time difference can alter the ultimate outcome of the infarction. Time is a direct measure to the quality of the hospital. According to Bradley, these wait times are an indicator of how efficiently a team of doctors, nurses and technicians can work to deliver quality health care.

Yale-New Haven Hospital spokesman Vin Petrini said YNHH measures up to these standards of speedy health care due to well-established clinical pathways that have developed over the past three years.

“We have basically stripped out subjectivity completely from our health care,” Petrini said. “This is an issue we have been looking at for a number of years now, and we have seen great improvement and much of that has to do primarily with our level of sophistication. We have implemented clinical pathways and guidelines that ensure that every patient, regardless of ethnicity, is seen by degree of priority.”

Formulating a multi-step solution to this problem is the next step for physicians and hospital administrators around the country.

“The real question here is how to solve this problem in health care disparities,” Krumholz said. “We have to make sure that hospitals express commitment in providing higher quality care and we must try to understand what the underlying causes of this lesser-quality health care are.”

Nonprofit organizations such as Minority Health Care Communications, which organizes the largest conferences on AIDS in African-American and Latino communities, see training of physicians in this country as part of the problem.

“We need to make cultural competency training a mandatory component of the training of a physician in this country so they are educated in matters like drug use and poverty and can better understand where their patients come from,” said K. Mary Hess, president of MHCC. “Otherwise, there is no turning around on matters like these.”

Hospital administrators like Petrini also view this as a pertinent solution to this problem.

“We absolutely agree that education in cultural competence should be an integral part of a doctor’s training, and we have tried to eliminate any of those sort of barriers here by our strict clinical guidelines and our commitment to quality care,” Petrini said.