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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.
The Annals of Thoracic Surgery
|June 30, 2004
Summary
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.