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Explaining disparities in access to high-quality cardiac surgeons
Barbara M Rothenberg1, Thomas Pearson, Jack Zwanziger
1Excellus BlueCross BlueShield, Rochester, New York, USA.
Insights
Racial minorities undergoing coronary artery bypass graft (CABG) surgery are more likely to be treated by surgeons with higher mortality rates, even after accounting for patient and hospital factors. Addressing disparities requires focusing on access to high-quality care.
Area of Science:
- Health Services Research
- Cardiovascular Surgery
- Health Disparities
Background:
- Racial disparities in access to coronary artery bypass graft (CABG) surgery are well-documented.
- Minority patients undergoing CABG are disproportionately treated by lower-quality providers.
Purpose of the Study:
- To examine the relationship between patient race and surgeon quality for CABG surgery.
- To determine if racial disparities persist in receiving care from high-quality cardiac surgeons.
Main Methods:
- Utilized New York State hospital discharge data (1996-1997) for CABG patients.
- Combined discharge data with surgeon risk-adjusted mortality rates.
- Performed statistical analysis controlling for patient comorbidities, socioeconomic status, hospital, and surgeon volume.
Main Results:
- African Americans and Asian/Pacific Islanders were treated by surgeons with higher risk-adjusted mortality rates compared to white patients.
- Disparities were partly explained by hospital admission and patient socioeconomic factors, but race remained associated with higher surgeon mortality.
- Treatment by lower-volume surgeons also contributed to the observed racial disparities.
Conclusions:
- Eliminating health disparities requires addressing not only access to care but also access to high-quality care.
- Interventions should focus on ensuring equitable distribution of high-quality cardiac surgical care across racial groups.
Background:
Racial disparities in access to coronary artery bypass graft (CABG) surgery are well documented. Recent evidence shows that even when patients receive CABG surgery, racial minorities are more likely to be treated by lower quality providers.
Methods:
New York State (NYS) hospital discharge data for 1996 and 1997 for patients undergoing CABG surgery were combined with risk-adjusted mortality rates for cardiac surgeons calculated by the NYS Department of Health. Statistical analysis was performed to determine the relationship between patients' race and the quality of the surgeon performing the CABG, as measured by the surgeon's risk-adjusted mortality rate, after controlling for patient characteristics such as comorbidities and socioeconomic status; the hospital where the surgery was performed; and the number of surgeries the surgeon performed over a 3-year period.
Results:
African Americans and Asian/Pacific Islanders are treated by surgeons with higher risk-adjusted mortality rates compared with whites. This association does not appear to be a result of inadequate risk adjustment. It is explained to some degree by the hospital to which these patients are admitted, and to a lesser degree by (1) the education and income level in the patient's zipcode of residence and (2) being treated by a low-volume surgeon. After controlling for these factors, race continues to be associated with treatment by a surgeon with a higher risk-adjusted mortality rate.
Conclusions:
Efforts to achieve the "Healthy People 2010" goals of eliminating health disparities should address not only access to care, but also access to high-quality care.
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