Racial profiling: the unintended consequences of coronary artery bypass graft report cards
Rachel M Werner1, David A Asch, Daniel Polsky
1Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pa, USA. rwerner@wharton.upenn.edu
Insights
New York's cardiac surgery report cards initially widened racial disparities in bypass surgery (CABG) use. However, these disparities later decreased, returning to pre-report card levels.
Area of Science:
- Health Services Research
- Health Equity
- Cardiovascular Surgery
Background:
- Public release of healthcare quality data (report cards) aims to improve care.
- Potential unintended consequences include physicians avoiding high-risk patients, potentially exacerbating health disparities.
- Racial and ethnic minorities may be disproportionately affected if perceived as higher risk.
Purpose of the Study:
- To examine the impact of New York's Coronary Artery Bypass Grafting (CABG) report card on racial and ethnic disparities in cardiac care.
- To assess changes in the utilization of CABG, Percutaneous Transluminal Coronary Angioplasty (PTCA), and cardiac catheterization among different racial groups.
Main Methods:
- Quasi-experimental design comparing New York to control states before and after the CABG report card release.
- Analysis of hospitalization data for acute myocardial infarction.
- Adjustment for patient and hospital characteristics and national trends in disparities.
Main Results:
- A significant increase in the racial and ethnic disparity in CABG use was observed in New York immediately following the report card release.
- No significant changes in disparities for CABG were noted in comparison states.
- No differential changes in racial and ethnic disparities for cardiac catheterization or PTCA were found between New York and comparison states.
Conclusions:
- The introduction of CABG report cards in New York was associated with a temporary widening of the disparity in CABG utilization between white and minority patients.
- Over time, the observed increase in disparities diminished to baseline levels.
Background:
Although public release of quality information through report cards is intended to improve health care, there may be unintended consequences of report cards, such as physicians avoiding high-risk patients to improve their ratings. If physicians believe that racial and ethnic minorities are at higher risk for poor outcomes, report cards could worsen existing racial and ethnic disparities in health care.
Methods And Results:
To investigate the impact of New York's CABG report card on racial and ethnic disparities in cardiac care, we estimated differences in the use of CABG, PTCA, and cardiac catheterization between white versus black and Hispanic patients hospitalized for acute myocardial infarction in New York before and after New York's first CABG report card was released, adjusting for patient and hospital characteristics and national changes in racial and ethnic disparities in cardiac care. The racial and ethnic disparity in CABG use significantly increased in New York immediately after New York's CABG report card was released, whereas disparities did not change significantly in the comparison states. There was no differential change in racial and ethnic disparities between New York and the comparison states in the use of cardiac catheterization or PTCA after the CABG report card was released. Over time, this increase in racial and ethnic disparities decreased to levels similar to those before the release of report cards.
Conclusions:
The release of CABG report cards in New York was associated with a widening of the disparity in CABG use between white versus black and Hispanic patients.
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