Racial disparity, primary care, and specialty referral

Area of Science:

• Health Services Research
• Health Disparities
• Primary Care Medicine

Background:

• Racial disparities persist in healthcare access and outcomes.
• Referral-sensitive admissions are procedures where timely access is crucial and influenced by primary care.
• Understanding the role of primary care physicians (PCPs) is key to addressing these disparities.

Purpose of the Study:

• To investigate the association between primary care physician (PCP) supply and racial disparities in referral-sensitive hospital admissions.
• To determine if PCP density impacts access to discretionary procedures differently across racial groups.

Main Methods:

• Analysis of 1995 hospital discharge data for New York residents aged 20-64, hospitalized in NY or contiguous states.
• Utilized multivariate logistic models to compare PCP supply effects on referral-sensitive vs. marker admissions for White, Black, and Hispanic populations.
• Linked discharge data with Area Resource File and American Hospital Association survey files.

Main Results:

• Increased PCP density was associated with a higher probability of Black admissions compared to White admissions for referral-sensitive procedures.
• This association was observed when compared to marker (urgent) admissions, suggesting a specific effect on discretionary care.

Conclusions:

• The supply of primary care physicians is significant for managing referral-sensitive admissions.
• Higher PCP density may enhance access to specialty procedures for non-White populations, particularly Black individuals.
• Increased PCP density shows potential to narrow racial disparities in specialty referrals and improve the referral process for non-Whites.