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Racial differences in access to high-quality cardiac surgeons
D B Mukamel1, A S Murthy, D L Weimer
1Department of Community and Preventive Medicine, University of Rochester Medical Center, NY 14642, USA. dana_mukamel@urmc.rochester.edu
Insights
Racial minorities with cardiac artery bypass graft (CABG) surgery access in New York were more likely to receive care from lower-quality surgeons, indicating disparities in provider selection even when access is granted.
Area of Science:
- Health Services Research
- Surgical Quality
- Health Equity
Background:
- Racial disparities in access to cardiac artery bypass graft (CABG) surgery are established.
- Previous research has not fully explored racial differences in the quality of cardiac surgeons providing care.
Purpose of the Study:
- To investigate racial disparities in access to high-quality cardiac surgeons for CABG procedures.
- To determine if race influences the quality of surgeons accessed by patients undergoing CABG surgery.
Main Methods:
- Analysis of 11,296 CABG surgeries in New York State from 1996.
- Utilized regression techniques to assess the relationship between patient race, insurance type (HMO vs. fee-for-service), and surgeon quality.
- Surgeon quality was measured by risk-adjusted mortality rate (RAMR).
Main Results:
- Non-White patients were more likely than White patients to be treated by higher RAMR surgeons.
- This disparity was observed in both Health Maintenance Organization (HMO) enrollees (11.7% higher likelihood, P < .1) and fee-for-service enrollees (5.4% higher likelihood, P < .05).
Conclusions:
- Racial minorities undergoing CABG surgery are disproportionately likely to receive care from lower-quality providers, even when they gain access to services.
- These findings highlight significant inequities in the quality of surgical care based on race.
Objectives:
Racial differences in access to cardiac artery bypass graft (CABG) surgery are well documented. This study extends the literature by examining racial differences in access to high-quality cardiac surgeons.
Methods:
The analyses included 11,296 CABG surgeries in New York State in 1996. Regression techniques were used to identify significant associations between a patient's race, health maintenance organization (HMO) enrollment, and the quality of the surgeon performing the surgery, measured by the surgeon's risk-adjusted mortality rate (RAMR).
Results:
Non-Whites were more likely than Whites to have access to surgeons of higher RAMR, by 11.7% among HMO enrollees (1-tailed P < .1) and by 5.4% among fee-for-service enrollees (1-tailed P < .05).
Conclusions:
Even when racial minorities do gain access to CABG services, they are more likely that non-Whites to receive care from lower-quality providers.
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