Fatal malnutrition 6 years after gastric bypass surgery.

Comment. Over 4 years, national performance on D2B times improved dramatically, and these improvements were accompanied by a marked narrowing of racial disparities in D2B times. Improvements may be due to a number of factors, including public reporting of D2B data, the cumulative experience of hospitals performing primary percutaneous coronary intervention, and the dissemination of effective strategies to reduce delays through the D2B Alliance and Mission Lifeline. Previously, we noted that a large proportion of racerelated disparities in D2B times was attributable to differences in the care delivered at hospitals that treated a higher proportion of black patients. The current data are consistent with that observation. If overall improvements in D2B times have reduced variation across hospitals, one would expect differences by race to narrow. As such, continued efforts are necessary to eliminate the remaining race-based differences in D2B times and continue to improve overall times. Alternatively, the analysis could be confounded by changes in case mix as well as changes in measure exclusion criteria over time. However, there is no evidence to suggest that these exclusion criteria would disproportionately affect patients based on race. Our analysis suggests that racial disparities in D2B times have significantly narrowed over time and that improving national quality of care appears to have not only improved overall performance but also diminished disparities.